OSTEOARTHRITIS · OSTEOARTHROSIS

Osteoartritis · Osteoartroza (OA) najčešći je mišićnokoštani problem u ljudi iznad pedeset godina života. Karakterizirana je fokalnom degeneracijom zglobne hrskavice i formacijom nove kosti u subhondralnom prostoru i na rubovima zglobnih površina. Bolest zahvaća cijeli zglob (kost, hrskavicu, zgobnu čahuru, ligamente, okolne miišiće). Jednom kada se postavi dijagnoza osteoarthritisa, dva su cilja terapije: ukloniti bol i očuvati funkciju. Do danas kliničari nemaju terapiju koja može modificirati progresiju bolesti, tako da je za sada terapija simptomatska. Temelji se na smanjenju upale, smanjenju bola u zglobu i smanjenju funkcionalne onesposobljenosti.Osteoarthritis · Osteoarthrosis (OA) is the most common musculoskeletal problem in people age 50. It is characterised by the focal degeneration of joint cartilage and new bone formation at the base of the cartilage lesion (subhondral bone) and at the joint margins (osteophytes). The disease involves entire joint organ (bone, cartilage, supporting elements). Once the diagnosis of OA has been established there are two objectives of therapy: to relieve pain and to preserve function. As so far clinicians have not had effective treatments that alter disease progression, therapy must focus on modifying the symptoms, including the reduction of inflamation, joint pain and functional disabilit

CALCIFYING TENDINITIS OF ROTATOR CUFF

Kalcificirajući tendinitis mišića rotatorne manšete ramena donekle je česta bolest. Cilj je preglednog rada razjasniti osnovne patogenetske mehanizme, dijagnostiku i principe liječenja. Ovaj posebni entitet nije posljedica distrofične kalcifikacije degeneriranih tetivnih vlakana nego stanično posredovan reaktivni proces. U stvarnosti nakon stvaranja depozita i faze mirovanja slijedi resorpcija i potpuno cijeljenje tetive. Liječenje je konzervativno, a kirurško tek iznimno i to u fazi kada je rendgenološki depozit jasno ograničen i homogen, bez znakova resorpcije. Ako su vidljivi znaci resorpcije, indicirane su samo mjere konzervativnog liječenja i bolest završava potpunom resorpcijom kalcifikata i cijeljenjem.Calcifiying tendinitis of rotator cuff is a relatively common occurence. The aim of this review is to clarify basic pathogenic mechanisms, diagnostic and therapy principles. This entity is not due to dystrophic calcification of the degenerative tendinous tissue but due to a cell mediated reactive process. In fact, following the formation of a deposit, resorption usually ensues, which in turn will be followed by a tendon reconstitution. If patent conservative measures fail, surgery should only be contemplated in the presence of radiologically dense, homogenous and well delineated deposits which indicate that the resorptive activity has not set in. If, on the other hand, there is evidence of an ongoing resorption, the decision for surgery should be postponed since the natural resorption will occur

OSTEOARTHRITIS · OSTEOARTHROSIS

Osteoartritis · Osteoartroza (OA) najčešći je mišićnokoštani problem u ljudi iznad pedeset godina života. Karakterizirana je fokalnom degeneracijom zglobne hrskavice i formacijom nove kosti u subhondralnom prostoru i na rubovima zglobnih površina. Bolest zahvaća cijeli zglob (kost, hrskavicu, zgobnu čahuru, ligamente, okolne miišiće). Jednom kada se postavi dijagnoza osteoarthritisa, dva su cilja terapije: ukloniti bol i očuvati funkciju. Do danas kliničari nemaju terapiju koja može modificirati progresiju bolesti, tako da je za sada terapija simptomatska. Temelji se na smanjenju upale, smanjenju bola u zglobu i smanjenju funkcionalne onesposobljenosti.Osteoarthritis · Osteoarthrosis (OA) is the most common musculoskeletal problem in people age 50. It is characterised by the focal degeneration of joint cartilage and new bone formation at the base of the cartilage lesion (subhondral bone) and at the joint margins (osteophytes). The disease involves entire joint organ (bone, cartilage, supporting elements). Once the diagnosis of OA has been established there are two objectives of therapy: to relieve pain and to preserve function. As so far clinicians have not had effective treatments that alter disease progression, therapy must focus on modifying the symptoms, including the reduction of inflamation, joint pain and functional disabilit

THE PREVENTION VALUE OF DEVELOPMENTAL DYSPLASIA OF THE HIP FROM HIPPOCRATES UNTIL TODAY

Kao najčešća anomalija lokomotornog aparata, priroðeno iščašenje kuka je i dalje velika nepoznanica. O organizaciji prevencije luksacijske anomalije kuka te o njezinoj vrijednosti govore mnogi objavljeni članci u stručnoj literaturi. U ovom radu pokušat ćemo odgovoriti na pitanje: Kada je prevencija luksacijske anomalije kuka doista učinkovita? Rješenje je u daljnjem poboljšanju same organizacije prevencije ove priroðene anomalije. U okviru organizacijske sheme prevencije luksacijske anomalije kuka autori posebno ističu potrebu da što manje liječnika treba biti uključeno u zaštiti dječjeg kuka u istog djeteta. Ističu, isto tako, da pacijenta poslije repozicije priroðenog iščašenja kuka, zbog stalne prijetnje artroze kuka, treba pratiti ne samo do pune koštane zrelosti, već tijekom cijelog života.Developmental dysplasia of the hip is the most common anomaly of the musculosceletal system and still not much is known about it. A great number of published materials in printed publications discuss the organisation of the prevention of DDH. This work will try to give answer to the question as in which case the prevention of DDH can be really effective. The solution lies in further development of the organisation of the prevention of this congenital anomaly. Within the organisational scheme of DDH the authors emphasize the importance of the smallest posible number of doctors to be involved in the preventive care of the hip in the same child. The patient treated for the congenital dislocation of the hip should be followed not only up to the full osteomaturity of the hip, but during all his life because of the continuous threat of the development of arthrosis

TREATMENT OF TIBIAL NONUNION WITH INFECTION AND BONE DEFECT WITH METHOD OF CENTRAL GRAFTING

Modificiranom tehnikom “centralnoga graftinga”, koja se sastoji u polaganju autolognoga koštanog presatka na prednju stranu interosalne membrane, liječčli smo deset bolesnika s inficiranom pseudoartrozom tibije i koštanim defektom. U svih je bolesnika stvorena tibiofibularna sinostoza koja je mehanički i funkcionalno udovoljavala svakodnevnim aktivnostimaBy modified techniques of central grafting we treated ten patients with persistent tibial nonunion with infection and bone defect. The technique involves placement of autogenus corticocancellous bone from the iliac crest on the anterior surface to the interoseal membrane with the aim to create a tibiofibular synostosis. New-formed bones mass was able to fulfill mechanically and functionally the demand of every day living activit

TREATMENT OF TIBIAL NONUNION WITH INFECTION AND BONE DEFECT WITH METHOD OF CENTRAL GRAFTING

Modificiranom tehnikom “centralnoga graftinga”, koja se sastoji u polaganju autolognoga koštanog presatka na prednju stranu interosalne membrane, liječčli smo deset bolesnika s inficiranom pseudoartrozom tibije i koštanim defektom. U svih je bolesnika stvorena tibiofibularna sinostoza koja je mehanički i funkcionalno udovoljavala svakodnevnim aktivnostimaBy modified techniques of central grafting we treated ten patients with persistent tibial nonunion with infection and bone defect. The technique involves placement of autogenus corticocancellous bone from the iliac crest on the anterior surface to the interoseal membrane with the aim to create a tibiofibular synostosis. New-formed bones mass was able to fulfill mechanically and functionally the demand of every day living activit

THE PREVENTION VALUE OF DEVELOPMENTAL DYSPLASIA OF THE HIP FROM HIPPOCRATES UNTIL TODAY

Kao najčešća anomalija lokomotornog aparata, priroðeno iščašenje kuka je i dalje velika nepoznanica. O organizaciji prevencije luksacijske anomalije kuka te o njezinoj vrijednosti govore mnogi objavljeni članci u stručnoj literaturi. U ovom radu pokušat ćemo odgovoriti na pitanje: Kada je prevencija luksacijske anomalije kuka doista učinkovita? Rješenje je u daljnjem poboljšanju same organizacije prevencije ove priroðene anomalije. U okviru organizacijske sheme prevencije luksacijske anomalije kuka autori posebno ističu potrebu da što manje liječnika treba biti uključeno u zaštiti dječjeg kuka u istog djeteta. Ističu, isto tako, da pacijenta poslije repozicije priroðenog iščašenja kuka, zbog stalne prijetnje artroze kuka, treba pratiti ne samo do pune koštane zrelosti, već tijekom cijelog života.Developmental dysplasia of the hip is the most common anomaly of the musculosceletal system and still not much is known about it. A great number of published materials in printed publications discuss the organisation of the prevention of DDH. This work will try to give answer to the question as in which case the prevention of DDH can be really effective. The solution lies in further development of the organisation of the prevention of this congenital anomaly. Within the organisational scheme of DDH the authors emphasize the importance of the smallest posible number of doctors to be involved in the preventive care of the hip in the same child. The patient treated for the congenital dislocation of the hip should be followed not only up to the full osteomaturity of the hip, but during all his life because of the continuous threat of the development of arthrosis

Prognostic Value of Refined Wiberg’s Angle in Hip Development

There are many angles measured on hip radiographs, but their prognostic value for hip development in patient with DDH is controversial. Our aim was to find out how the development of congenitally luxated hip could be predicted after reduction using Wiberg’s CE angle and CE angle refined according to Ogata. 119 hips of 61 patients were retrospectively evaluated after reduction from 3 months of age until at least full osteomaturity. According to results of CE angles measurements good and poor hip development group were formed. Healthy hips of the patients with unilateral DDH were considered to be the control group. Negative linear trend of the curve connecting Wiberg’s CE angle values measured within first postreductive years is a poor prognostic sign of hip development as are absolute negative values of refined CE angles. In cases where negative initial refined CE angles are combined with negative linear trend of Wiberg’s CE angles prognosis is extremely poor. Both Wiberg’s and Ogata’s CE angle are of prognostic value regarding hip development and should be measured when evaluating AP radiographs of infant’s hip

Treatment of Infected Tibial Nonunion with Bone Defect Using Central Bone Grafting Technique

Treatment of infected tibial nonunion with bone defect represents a challenge for every orthopaedic surgeon. Various methods of treatment have been described for nonunions with infection, bone loss or both. One of them is the central bone grafting technique, which is a safe and effective treatment for nonunions of the tibia. The technique involves placement of autogenous cancellous bone from the iliac crest on the anterior surface of the interosseous membrane with the aim of creating a tibiofibular synostosis. We present the results of uncontrolled, retrospective and continuous series of ten patients treated by a central bone grafting technique for infected tibial nonunion with bone loss. Mean follow-up period was 12 (10–15) years. Most injuries were a result of war injuries. Clinically and radiologically confirmed bony healing with total consolidation of the graft was achieved in all patients within a period of 10–12 months without further bone grafting. The newly-formed bone mass was able to fulfil the mechanical and functional demands of everyday life activities. Once again, the central bone grafting technique has shown to be a safe, reliable and effective method of treatment for infected tibial nonunion with bone defect

FRACTURES OF DISTAL RADIUS

Prijelomi distalnog radiusa veoma su česte ozljede. Danas znamo da su to kompleksne ozljede s različitom prognozom što ovisi o više čimbenika, uključujući tip prijeloma i metodu liječenja. Oko 75% prijeloma podlaktice zauzimaju prijelomi distalnog radijusa. Colesov tip prijeloma zastupljen je u oko 90% tih slučajeva. Veći je dio tih prijeloma stabilan i liječen sa zatvorenom repozicijom i gipsanom imobilizacijom. Ostali nestabilni prijelomi zahtijevaju druge metode liječenja, a to su: perkutano postavljanaje žica, perkutani pin i gips, vanjska fiksacija, minimalno invazivna otvorena repozicija i otvorena repozicija i unutarnja fiksacija.Fractures of the distal end of the radius are among the most common fractures.Today, these fractures are recognized as very complex injuries vith a variable prognosis that depends on many factors including fracture type and method of treatment. About 75% of forearm fractures involve the distal radius. Colles type account for 90% of distal radius fractures. Many distal radius fractures are stable and can be treated by a closed reduction and cast imobilisation. Other fractures are unstable and require additional methods of treatment. Options for these fractures include percutaneus pining, pins and plaster, external fixation, limited open reduction and open reduction and internal fixation