Nova metoda liječenja patele alte kod bolesnice s cerebralnom paralizom: prikaz slučaja s pregledom literature

Patella alta is a common condition in ambulatory patients with cerebral palsy, especially those with crouch gait. The treatment of symptomatic patella alta in such patients is complex and conservative methods seldom provide satisfactory results. Thus, patellar tendon advancement surgery is often required and can be, if necessary, combined with other surgical procedures. Here, we report a case of combining both conservative method and surgical procedure in a 26-year-old female patient with cerebral palsy and bilateral patella alta. One month prior to surgical intervention we administered a botulinum toxin type A (BTX-A) in the ipsilateral quadriceps. Reduced muscle spasticity of the knee extensor mechanism facilitated the patellar tendon shortening procedure and yielded excellent postoperative results. After a six-month postoperative rehabilitation course, the patient had no pain and the knee range of motion improved from 5-50° preoperatively to 0-140° postoperatively in both knees. To our knowledge, we are the first to report a use of preoperative BTX-A in the treatment of patella alta in a patient with cerebral palsy. The efficacy and safety of this treatment modality may give encouragement to a wider use of preoperative BTX-A in order to facilitate surgical intervention and postoperative rehabilitation in cases of muscle spasticity.Patela alta relativno je često stanje u ambulatornih bolesnika s cerebralnom paralizom, osobito onih koji se prezentiraju čučećim hodom. Liječenje simptomatske patele alte u takvih je bolesnika složeno i konzervativne metode liječenja rijetko daju zadovoljavajuće rezultate. Stoga je u većini slučajeva indicirano operacijsko liječenje u smislu izolirane distalizacije patele ili udružene s drugim kirurškim zahvatima. U ovom radu prikazan je slučaj udružene primjene konzervativne metode liječenja i kirurškog zahvata kod 26-godišnje bolesnice s cerebralnom paralizom i obostranom patelom altom. Mjesec dana prije kirurške intervencije apliciran je botulinum toksin tip A (BTX-A) u ipsilateralni mišić kvadricepsa. Posljedično smanjena spastičnost mišića ekstenzora koljena olakšala je postupak skraćivanja ligamenta patele i omogućila je sigurniju rehabilitaciju. Šest mjeseci nakon operacije pojedinog koljena bolesnica se nije žalila na bolove, a opseg pokreta oba koljena poboljšan je s 5-50° prije operacije na 0-140° poslije operacije. Ovim radom prvi smo izvjestili o uporabi prijeoperacijskog BTX-A u liječenju patele alte kod bolesnika sa cerebralnom paralizom. Dokaz o učinkovitosti i sigurnosti ove metode liječenja mogao bi potaknuti širu prijeoperacijsku primjenu BTX-A kako bi se, u slučajevima povišenog tonusa mišića, olakšala kirurška intervencija i unaprijedila poslijeoperacijska rehabilitacija

Rekonstrukcija distalne ulne nakon resekcije gigantocelularnog tumora

Giant cell tumour (GCT) is a rare, benign tumour, but it has a locally aggressive nature and a high rate of recurrence. A wide en-bloc resection of the distal part of the ulna, with or without stabilisation of the ulnar stump, is the recommended treatment option. Functional results after that kind of surgery are mostly satisfying but, in some cases, it can result in wrist instability, causing pain and weakness of grip strength. That is why when it comes to young people, with high functional demands, we prefer reconstruction of distal ulna and distal radioulnar joint after an en-bloc resection of the distal ulna. The distal ulna is reconstructed with an autologous free fibular graft and the distal radioulnar joint is stabilised with an autologous palmaris longus tendon graft. We present our operative technique and good functional results of three young patients treated with this procedure. Our results confirm the hypothesis that the reconstruction of the distal ulna and the distal radioulnar joint leads to a satisfactory functional result in young and active patients with higher functional demands.Gigantocelularni tumour distalnog dijela ulne je izrazito rijedak, lokalno agresivan tumor sa velikom vjerojatnošću recidiva. Danas preporučena i najčešće korištena metoda liječenja ovih bolesnika je široka resekcija ulne sa ili bez stabilizacije proksimalnog dijela ulne tetivom. Funkcionalni rezultati ovakvog načina liječenja su uglavnom zadovoljavajući, ali se neki slučajevi kompliciraju razvojem nestabilnosti ručnog zgloba i značajnim smanjenjem snage šake. Zato u mladih osoba sa visokim funkcionalnim zahtjevima preferiramo nakon resekcije tumora učiniti rekonstrukciju distalne ulne i distalnog radioulnarnog zgloba. Distalnu ulnu rekonstruiramo pomoću slobodnog koštanog presatka dijafize bolesnikove fibule, a distalni radioulnarni zglob stabiliziramo koristeći presadak bolesnikove tetive mišića palmaris longusa. Ovim radom prikazujemo našu operativnu tehniku i dobre funkcionalne rezultate troje mladih bolesnika operiranih na ovaj način. Naši rezultati potvrđuju pretpostavku kako rekonstrukcija distalne ulne i distalnog radioulnarnog zgloba dovode do zadovoljavajućeg funkcionalnog rezultata u mladih i aktivnih bolesnika sa većim funkcionalnim zahtjevima

Articular cartilage repair techniques exploiting intrinsic healing capacity – which one is the best?

In this review article articular cartilage structure and organization is explained, followed by brief discussion on articular cartilage focal lesion development and subsequent endogenous regeneration, which mainly relies on presence of intrinsic healing capacity. In case of full thickness focal chondral defects intrinsic healing ability is insufficient and full spontaneous repair is almost never achieved. In those cases, cartilage repair techniques are indicated. Currently, the most commonly used articular cartilage repair techniques include three groups of techniques such as: bone marrow stimulation, osteochondral allografting/autografting and autologous chondrocyte implantation. These groups are further divided to specific cartilage repair techniques, discussed in detail and compared to other approaches. The information provided is intended to allow proper critical judgment and to answer the question “Which articular cartilage repair technique is the best for the particular patient?”

Orthopedic and cutaneous reactions to nickel after total hip replacement

Implant degradation products have shown signs of a cutaneous allergic response after implantation of a metal orthopedic replacement, loosening and failure of the joints as well as skin rashes, general fatigue, pain, and impaired wounds and bone healing. The prevalence of contact skin sensitivity in patients with a joint replacement device is higher than that in the general population. This delayed hypersensitivity to metallic orthopedic implants is more clearly defined and is a contributing factor to implant failure. Nickel was associated with hypersensitivity responses as the first cause in metallic orthopedic implants as early as 1966 by Foussereau and Laugieru and is a commonly used metal in alloys because it grants necessary strength and durability to the implant. Herein we report on delayed hypersensitivity to nickel sulfate in a patient with pain, fatigue, and contact allergic dermatitis in both inguinal regions, with instability of the left acetabular part and with five hip replacements from 1987 to 2013. The findings of this report support that primary sensitization to a metal due to an implant itself might develop. Proper investigation in patients with history or prior hypersensitivity reactions to metals and test evaluation before orthopedic device implantation is needed.  before orthopedic device implantation is needed. </p

Veća učestalost revizijskih zahvata i aseptičkog razlabavljenja totalnih endoproteza koljena sa stražnjom stabilizacijom u usporedbi s totalnom endoprotezom koljena s očuvanim stražnjim križnim ligamentom istog tipa endoproteze – retrospektivna studija jednog centra na 580 koljena

The purpose of this study was to evaluate the 4-year survivorship of total knee arthroplasty (TKA) of a single manufacturer and determine whether failure rates differ between the cruciate-retaining (CR) and the posterior-stabilised (PS) type of implant. In addition, possible causes of revision were analysed as well. A retrospective analysis of 580 TKAs, with either the CR or the PS type of the Biotech Future Knee endoprosthesis (BIOTECH GmbH, Garbsen-Berenbostel, Germany) was performed. The 4-year survivorship for revision of any cause in all cases was 89.14%, with aseptic loosening being the most common cause of revision (53.9%). Regarding the type of implant model, the revision rate was higher in the PS group compared to the CR group (13.7% to 8.0%, respectively, p=0.027). The Cox regression models suggested that the type of prosthesis was a significant predictor of the need for revision (HR, 0.442; 95% CI, 0.234-0.833). In conclusion, our study has shown higher revision rates with the PS implant type when compared to the CR implant type with a higher rate of aseptic loosening in the PS group. Further studies are needed to determine the cause of these results and to investigate whether the problem is specific to the implant.Primarne endoproteze koljena razlikuju se u dizajnu s obzirom je li stražnja ukrižena sveza održana (CR) ili žrtvovana (PS). Cilj istraživanja bio je ispitati 4-godišnje preživljenje totalne endoproteze koljena jednog proizvođača te utvrditi postoje li razlike s obzirom na CR ili PS dizajn endoproteze. Također, analizirani su mogući uzroci revizijskih zahvata. Retrospektivno je analizirano 580 koljenskih (PS i CR) endoproteza Biotech Future Knee (BIOTECH GmbH, Garbsen-Berenbostel, Germany). Ukupno 4-godišnje preživljenje ispitivanih endoproteza je 89.14%, a kao najčešći uzrok revizijskog zahvata zabilježeno je aseptičko razlabavljenje endoproteze (53.9%). S obzirom na dizajn endoproteze, postotak revizijskih zahvata je bio viši u PS nego u CR grupi(13.7% i 8.0%, p=0.027). Coxov regresijski model upućuje na dizajn endoproteze kao značajan prediktor potrebe za revizijskim zahvatom (HR, 0.442; 95% CI, 0.234-0.833). U zaključku, ovo istraživanje utvrdilo je viši postotak revizijskih zahvata kod PS dizajna u usporedbi s CR dizajnom endoproteze. Potrebne su dodatne studije kako bi se utvrdilo je li opažena razlika specifična za dizajn endoproteze ili ispitivani implantat

Peroneal tendoscopy – more than just a solitary procedure: case-series

This study presents a series of 13 patients who underwent peroneal tendoscopy as a solitary or accessory procedure at our department in 2013. Patients were clinically diagnosed with peroneal tendons disorders and underwent an additional radiological assessment. Peroneal tendoscopy was carried out in a standard manner before any other arthroscopic or open procedure. Postoperative management depended on the type of pathology. We found 3 peroneus brevis tendon partial tears, 4 cases of a low-lying peroneus brevis muscle belly, 5 cases of tenosynovitis, and 1 case of an intrasheath peroneal tendon subluxation. In 5 patients peroneal tendoscopy was performed as a solitary procedure and in 8 patients as an accessory procedure – together with anterior or posterior ankle arthroscopy, combined posterior and anterior ankle arthroscopy, or open surgery. Both as a solitary and accessory procedure, peroneal tendoscopy was safe and successful, ie, all patients were without any symptoms at one-year follow-up. Our series of patients showed that peroneal tendoscopy can be used both as an independent procedure as well as a valuable accessory procedure

Peroneal tendoscopy – more than just a solitary procedure: case-series

This study presents a series of 13 patients who underwent peroneal tendoscopy as a solitary or accessory procedure at our department in 2013. Patients were clinically diagnosed with peroneal tendons disorders and underwent an additional radiological assessment. Peroneal tendoscopy was carried out in a standard manner before any other arthroscopic or open procedure. Postoperative management depended on the type of pathology. We found 3 peroneus brevis tendon partial tears, 4 cases of a low-lying peroneus brevis muscle belly, 5 cases of tenosynovitis, and 1 case of an intrasheath peroneal tendon subluxation. In 5 patients peroneal tendoscopy was performed as a solitary procedure and in 8 patients as an accessory procedure – together with anterior or posterior ankle arthroscopy, combined posterior and anterior ankle arthroscopy, or open surgery. Both as a solitary and accessory procedure, peroneal tendoscopy was safe and successful, ie, all patients were without any symptoms at one-year follow-up. Our series of patients showed that peroneal tendoscopy can be used both as an independent procedure as well as a valuable accessory procedure

Mortality and causes of death among Croatian male Olympic medalists

Aim To compare the overall and disease-specific mortality of Croatian male athletes who won one or more Olympic medals representing Yugoslavia from 1948 to 1988 or Croatia from 1992 to 2016, and the general Croatian male population standardized by age and time period. Methods All 233 Croatian male Olympic medalists were included in the study. Information on life duration and cause of death for the Olympic medalists who died before January 1, 2017, was acquired from their families and acquaintances. We asked the families and acquaintances to present medical documentation for the deceased. Data about the overall and disease-specific mortality of the Croatian male population standardized by age and time period were obtained from the Croatian Bureau of Statistics (CBS). Overall and disease-specific standard mortality ratios (SMR) with 95% confidence intervals (CI) were calculated to compare the mortality rates of athletes and general population. Results Among 233 Olympic medalists, 57 died before the study endpoint. The main causes of death were cardiovascular diseases (33.3%), neoplasms (26.3%), and external causes (17.6%). The overall mortality of the Olympic medalists was significantly lower than that of general population (SMR 0.73, 95% CI 0.56-0.94, P = 0.013). Regarding specific causes of death, athletes’ mortality from cardiovascular diseases was significantly reduced (SMR 0.61, 95% CI 0.38- 0.93, P = 0.021). Conclusions Croatian male Olympic medalists benefit from lower overall and cardiovascular mortality rates in comparison to the general Croatian male populatio