Association between risk factor for anteriror glenohumeral instability and bone loss in active sport players

Introduction: Practicing mass and professional sport is with growing popularity among   young people. Sports like football, basketball, volleyball, and contact disciplines - boxing, martial arts, etc. are highly connected to trauma. Shoulder dislocation is very frequent and in most cases turns into instability. The main cause for it is glenoid and/or humeral bone loss.Material and methods: For the period 2010-2015 in University Hospital `St. Marina` 22 patients with high physical activity were operated - 5 of them are professional sportsmen. Volume of bone lose is measured with CT and the method proposed by Sugaya. Indications for operative treatment were based on history, clinical examination, imaging and ISIS score. The performed operative treatment was coracoid transfer over glenoid rim. Results: All patients had significant for instability bone loss. The postoperative period was smooth and there were no instability recurrences detected during the follow-up period.Conclusions: Glenohumeral instability in sportsmen is a result of recurrent shoulder dislocations, main cause for which is glenoid and/or humeral bone loss. Detecting and measuring the level of this bone loss is of great importance for the correct treatment algorithm leading to joint stability and return to active and competitive sport activities

Custom hip arthroplasty

     Total hip replacement is rapidly growing procedure because of  pain relief ,restoring range of motion  and patient`s satisfaction. Primary go is to restore individual geometry of patient`s hip joint, long term components survival and most important- improving patient`s quality of life.  In past decades this surgery has several limitations as patient`s age, bone morphology ( incl. anatomical deformities) ,previous surgeries ,etc.  Recently , with the development of modern implants ( cups and stems) these limitations are past. Young patients indicated for THA are always great challenge , because their functional requirements , life expectancy ,anatomical variations (  due to congenital or acquired disorders) , greater mobility and higher risk of aseptic loosening.  Standart  cementless  stems have some unsolved issues as fixed  intra / extramedular  dimentions, proximal stress shielding, impingement, etc. They are based on 2D-planning and often have mismatch between acetabular and femoral center of rotation.  Custom femoral  stems are based on specific 3D- scan of the hip joint, which presents  individual  shape of  acetabulum and especially femoral canal. This allows  optimal bone support for the stem, preserving bone substance , excellent  contact bone-stem and most important- restores center of rotation.  For the period 2010-2014  we  operated  16 patients , 8 were  with Osteoarthrosis (OA); 4-with Avascular necrosis (AVN) ; 2 with dysplastic hips (DDH) and two with posttraumatic osteoarthrosis . Follow up is 6-42 months.  We perform THA with modified  posterior surgical approach with minimal femoral reaming, due to individual femoral rasp with the same size  as the customized  femoral stem. During  the follow up period we found no complications,Harris Hip Score was 97 pts.  and  85%  of  the patients had regular physical exercises for 3 weeks

The possibilities of osteopathy in the orthopedic practice

Bulgarian patients’ problems related to chronically recurring complaints in the locomotor apparatus prompted them to search for new possibilities to deal with the disease. Doctors in orthopedics and traumatology are the first medical specialists such patients seek help from. Related professionals applying manual techniques are chiropractic doctors, chiropractors and osteopaths. Historically, the practice of osteopathy began in the USA in 1874 and later spread throughout Europe and the Balkan Peninsula. Today, the presence of osteopathy in Bulgarian healthcare is indisputable, but to what extent it has found its place in the treatment of orthopedic problems is a question that still awaits its answer. The purpose of this article is to explore the essence and possibilities of the application of osteopathy in orthopedic practice

Revision total hip replacement using long curved fully hydroxyapatite-coated modular stems with distal interlocking

Successful femoral reconstruction in revision total hip replacement needs to address variable metadiaphyseal bone defects and still represents a controversial issue. We present our clinical experience with the use of two types of long revision, curved, fully hydroxyapatite (HA)-coated titanium femoral stems with distal interlocking. A group of 20 patients has been followed up clinically and radiographically for a period of 12.1 months (3-30 months). Indications included aseptic and septic loosening as well as adverse local tissue reactions (ALTR) to metal debris. The major complications in our series included postoperative instability and intraoperative periprosthetic femoral fracture. Revision curved modular fully HA-coated stems with distal interlocking provide for good primary stem stability and successful secondary osteointegration in revision total hip arthroplasty (THA) for both aseptic and septic loosening in the setting of femoral bone defects. Longer follow-up in a larger cohort of patients is needed to confirm the good and very good short-term results and assess femoral bone remodeling

Tranexamic acid in the management of blood-loss in TKA

Total knee replacement is one of most common orthopedic procedure, which is associated with significant blood-loss. Administration of tranexamic acid is one of the methods to decrease the perioperative bleeding and haemotransfusion necessity. In the Dept. of Orthopedics and Traumatology since 2013 have been made 383 TKA. In 250 patients were administrated 500 mg i.v. 10 min prior to first incision and 500 mg i.v. at tourniquet release. Topical use of TXA were used in 58 cases. Patients were administrated  with 1,5 g TXA in 100cc NaCl for 3 min. before deflation. Peri and postoperative blood-loss, hemoglobin level decrease and transfusion requirements were observed. Results showed about  45 % lower bleeding than the control group compared to i.v use and about 15% less bleeding compared to the topical application group. All the patients from control group required blood transfusion after surgery due to blood loss -  about 890 ml on average. Topical application group shows average blood-loss 560 ml. , and i.v. group about 460 ml blood-loss.None of the patients with i. v. application of TXA required blood transfusion. Blood loss in the groups administering TXA i.v. or topical is significantly lowerwith better results in i.v. aplication. Administration of TXA is safe and reliable method for reducing bleeding associated with TKA which decreases necessity of haemotransfusion.

DUAL MOBILITY CUPS REDUCE DISLOCATION RATE IN TOTAL HIP ARTHROPLASTY FOR DISPLACED FEMORAL NECK FRACTURES

PURPOSE: To assess the dislocation rate after total hip arthroplasty with dual mobility cup (DMC) for displaced femoral neck fractures and to compare the results with that of conventional total hip arthroplasty (THA) and bipolar hemiarthroplasty (BHA) in the same clinical setting at our institution. MATERIALS AND METHODS: 49 cases (47 patients) treated with total hip arthroplasty with DMC, 38 cases (38 patients) with BHA and 29 patients (29 cases) operated on with conventional THA were retrospectively reviewed. RESULTS: In the DMC total hip arthroplasty group, there were no dislocations (0%). %). One dislocation (3,1%) occurred in the BHA group, and 3 dislocations occurred (11,1%) in the THA group. ). There was a statistically significant difference in favour of DMC group compared to THA group regarding dislocation rate (p=0,05). Dislocation rate did not differ significantly between DMC and BHA groups. There was no significant difference in mortality, complications and re-operation rate between groups. CONCLUSION: Dual mobility cups significantly reduce dislocation rate in total hip arthroplasty performed for displaced femoral neck fractures compared to conventional total hip arthroplasty while similar advantage over bipolar hemiarthroplasty could not be demonstrated in the current study

First examinations with the newly installed posturographic platform at the University medical and dental center, Medical University – Varna, Bulgaria

BackgroundPosture of the human body aims to keep its balance when performing dynamic movements or in the static stance. Posturology is another term for the Global postural recalibration. It is the discipline which studies posture. Postural control is regulated by a complex system, known as the Tonic postural system. Stomatognathic system must not be excluded when discussing posture. Posturology enables clinicians to study the sensory information, entering the body and determine the sensor that work in a suboptimal manner.MethodsA clinical case of a female patient, fully diagnosed, using the newly implemented system, is presented. Apart from it, we have analyzed another fourteen patients. All first filled out specifically designed questionnaires and signed written informed consent forms. Static and dynamic postural, audiological, vestibular, visual and HSAT assessments were performed, along with a dental check-up.ResultsPatient had normal occlusal characteristics – class 1 Angle, but problems with the temporomandibular joint and slight hearing were present. No vestibular, posture (static or dynamic) or visual convergence abnormalities were detected. Refractive abnormalities were present. Apart from that, a group of patients with obstructive sleep apnea is presented. Changes of their posture and balance were studied.ConclusionsAll information gathered by the two integrated static and dynamic analysis systems, along with the postural analyzer, HSAT and dental analysis can be used to define therapeutic interventions and exercise programmes needed

Osteoplastic Reconstruction in Anterior Glenohumeral Instability with Acquired Glenoid Bone Loss /// Остеопластично възстановяване при предна раменна нестабилност със съпътстваща костна загуба на гленоида

[EN] The human shoulder is unique among the large joints with a specific position. This is the most commonly dislocated joint. When the static and dynamic stabilizers are damaged and the balance between movement and stability is disturbed, usually after an external force is applied, the result is shoulder dislocation. Glenohumeral instability is a common pathology affecting predominantly young patients. Instability can be manifested in many ways. Pain may be the only symptom in some patients, while others present with visible joint dislocation. The detailed understanding of anatomy, clinic, and biomechanics of glenohumeral instability are basis for correct diagnosis and treatment of this pathology. The instability of the glenohumeral joint is defined as the inability of the humeral head to remain centered in the glenoid fossa. This means excessive mobility of joint surfaces relative to each other. Bone defects of the glenoid and humerus head are a common finding in patients with anterior shoulder instability. The glenoid bone loss is a major factor in the failure of soft tissue stabilization. It is very important to recognize it and determine the degree of loss in order to establish the correct healing algorithm. Osteoplastic recovery of bone loss via corticoid transfer is a method of choice in patients with chronic instability and concomitant bone loss. The dissertation presents in detail the glenoid bone loss in anterior shoulder instability and the clinical and imaging results in a 5-year follow-up.[BG] Човешкото рамо е уникално сред големите стави със специфична позиция. Това е най-често луксираната става. Когато статичните и динамичните стабилизатори биват увредени и балансът между движение и стабилност се наруши, обикновено след приложена външна сила, резултатът е раменна луксация. Гленохумералната нестабилност е честа патология, засягаща предимно млади пациенти. Нестабилността може да се прояви по много начини. Болката може да е единственият симптом при някои пациенти, докато други се презентират с видима луксация на ставата. Подробното разбиране на анатомията, клиниката и биомеханиката на гленохумералната нестабилност са в основата на правилната диагноза и лечение на тази патология. Нестабилността на гленохумералната става се дефинира като невъзможност на хумералната глава да остане центрирана в гленоидната фоса. Това означава ексцесивна мобилност на ставните повърхности една спрямо друга. Костните дефекти на гленоида и хумералната глава са честа находка при пациенти с предна раменна нестабилност. Гленоидната костна загуба е основен фактор за неуспехите при мекотъканна стабилизация. От голямо значение е разпознаването й и определянето на степента на загуба , с оглед изграждане на правилен лечебен алгоритъм. Остеопластичното възстановяване на костната загуба посредством коракоиден трансфер е метод на избор при пациенти с хронична нестабилност и съпътстваща костна загуба. Дисертационният труд представя детайлно гленоидната костна загуба при предна нестабилност и клиничните и образни резултати при 5 –годишно проследяване

MENTORING IN THE FIELDS OF PHYSIOTHERAPY AND INTEGRATED CARE

creativecommons Index Copernicus Value: 2016 -90,65 SJIF (Scientific Journal Impact Factor): 2017 - 7,61 Global Impact Factor: 2015 - 0,787 JIFACTOR: 2015 - 0,5 back to 2018Jan-Mar;24(1) Journal of IMAB - Annual Proceeding (Scientific Papers) Publisher: Peytchinski Publishing ISSN: 1312-773X (Online) Issue: 2018, vol. 24, issue1 Subject Area: Medicine - DOI: 10.5272/jimab.2018241.1923 Published online: 07 March 2018 Original article J of IMAB. 2018 Jan-Mar;24(1):1923-1927 MENTORING IN THE FIELDS OF PHYSIOTHERAPY AND INTEGRATED CARE Gergana Nenova1ORCID logo Corresponding Autoremail, Paraskeva Mancheva1ORCID logo, Todorka Kostadinova2, Kalin Mihov3ORCID logo, Svetoslav Dobrilov3ORCID logo, 1) Training and research sector of Rehabilitation, Medical College - Varna, Medical University of Varna, Bulgaria. 2) Department of Health Economics and Management, Faculty of Public Health, Medical University of Varna, Bulgaria. 3) Department of Orthopedics and Traumatology, Medical University of Varna, Bulgaria. ABSTRACT: A survey on the opinion of students studying Rehabilitation as a major subject on the role of their mentors and their qualities in the "Student Practice project.” The aim of the study is to investigate the point of view of the students, involved in the "Student Practice" project, about the role and the qualities that mentors and academic coaches (physiotherapists) should possess in order to be created a selection criteria. Subject of the survey are 14 students studying at the Medical College of MU-Varna which study "Rehabilitation". These students participated in the "Students practice" project for the period November 2016 - March 2017. A feedback was sought from them through a questionnaire method with an exclusively prepared for the survey questionnaire. The results of the feedback from trainees showed their increased confidence in dealing with patients and their better integration within the work team. The knowledge and skills acquired by students in the "Student practices" project are a prerequisite for the development of mentoring as a priority for the state’s education policy, with clear indications for choosing the most appropriate mentor and setting clear tasks for the acquisition of specific knowledge