Artroskopsko liječenje ozljeda meniska u adolescenata: usporedba tehnike šivanja izvana-unutra i meniskealnih strelica

The aim of this study was to evaluate clinical and subjective outcomes of the meniscal dart technique in patients having undergone arthroscopic meniscal repair by comparing it with the outside-in suturing technique. From January 2006 until June 2017, case records of 37 patients having undergone arthroscopic meniscal repair were retrospectively reviewed. The patients were divided into two groups based on the technique used for meniscal repair, as follows: 18 patients in suture technique group and 19 patients in meniscal dart group. Each patient was analyzed for the following parameters: age, gender, mechanism of injury, side of injury and injured meniscus, injury localization regarding anatomic position, injury type and associated injuries. The patients that underwent meniscal repair were analyzed for type of repair technique, operating results and results of follow-up (Lysholm and International Knee Documentation Committee (IKDC) score). There were no statistically significant differences between the groups according to clinical outcomes except for anatomic injury localization (p=0.035). Median of operation time was 62.5 min in suture technique group and 70 min in meniscal dart group (p=0.184); median of hospital stay was 2 days for both groups (p=0.951); median of Lysholm score was 86.5 and 84.5 (p=0.651); and median of IKDC score was 81.05 and 81.6, respectively (p=0.986). Understanding the harmful impact of meniscectomy, arthroscopic meniscal repair should be attempted whenever possible. Our data support arthroscopic repair of meniscal tears, since both the suture technique and the meniscal dart technique are safe and successful in meniscal repair in children, with good long-term results and without important complications.Cilj ovoga istraživanja je bio analizirati kliničke i subjektivne ishode liječenja u bolesnika operiranih zbog ozljeda meniska te usporediti dvije skupine bolesnika operiranih različitim tehnikama popravka meniska. Od siječnja 2006. do lipnja 2017. godine u studiju je uključeno 37 bolesnika koji su liječeni artroskopski zbog rupture meniska. Bolesnici su podijeljeni u dvije skupine ovisno o vrsti kirurškog zahvata: jednu skupinu skupinu činilo je 18 bolesnika u kojih je meniskus šivan tehnikom postavljanja šavova, a drugu 19 bolesnika u kojih su upotrebljene strelice za fiksaciju meniska. Svakom ispitaniku analizirani su sljedeći parametri: dob, spol, mehanizam nastanka ozljede, lateralizacija ozljede i meniska, anatomska lokalizacija ozljede i pridružene ozljede. Ispitanicima koji su podvrgnuti tehnikama popravka meniska analizirani su još i vrsta kirurške tehnike popravka meniska, rezultati subjektivne evaluacije 4 tjedna nakon operacije putem upitnika Lysholm i IKDC (International Knee Documentation Committee) te komplikacije nakon operacije. Između skupina bolesnika operiranih tehnikom postavljanja šavova i tehnikom fiksacije meniska strelicama nije bilo značajne razlike u promatranim ishodima liječenja, osim za anatomsku lokalizaciju ozljede (p=0,035). Medijani operacijskog vremena u skupini bolesnika operiranih tehnikom postavljanja šavova iznosio je 62,5 min, dok je u skupini fiksacije meniska strelicama medijan operacijskog vremena iznosio 70 minuta (p=0,184). Medijan duljine hospitalizacije bio je 2 dana za obje skupine (p=0,951). Medijan vrijednosti ljestvice Lysholm za promatrane skupine bio je 86,5 i 84,5 (p=0,651), a ljestvice IKDC 81,05 i 81,6 (p=0,986). Poznavajući štetne učinke meniskektomije, tehnika popravka meniska je dugoročnije bolji odabir i trebala bi se provoditi kadgod je to moguće. Obje tehnike (tehnika postavljanja šavova i tehnika fiksacije meniska strelicama) su sigurne i uspješne u liječenju ruptura meniska u djece, bez značajnijih komplikacija te s dobrim dugoročnim rezultatima

Elastic Stable Intramedullary Nailing for Treatment of Pediatric Tibial Fractures: A 20-Year Single Center Experience of 132 Cases

Objective: The aim of this study was to analyze the outcomes and complications in children treated with elastic stable intramedullary nailing (ESIN) for tibial fractures. Methods: The study included 132 patients (92 males) with a median age of 11 years (IQR 10, 15) treated with ESIN for displaced tibial shaft fractures or dia-metaphyseal distal tibial fractures from March 2002 to March 2022. The median follow-up was 118.5 months (IQR 74.5, 170). The primary outcome was success rate, while secondary outcomes were the time of bone healing, length of hospital stay, and associated injuries. Demographic data, type and nature of fracture, indication for surgery, healing time, operative time, complications of treatment, and time to implant removal were recorded. Results: Complete radiographic healing was achieved at a median of 7 weeks (IQR 6, 9). Most of the patients (n = 111; 84.1%) had fractures localized in the shaft of the tibia. The most common injuries were acquired by road traffic accidents (n = 42) and by a fall in the same level (n = 29), followed by injuries from sport activities (n = 21) or motorbike accidents (n = 18). Associated injuries were reported in 37 (28%) children. Fractures were closed in the majority of the children (n = 100; 76%), while 32 (24%) children presented with an open fracture. Children with open fractures were significantly older than children with closed fractures (13.5 years (IQR 10, 15) vs. 11 years (IQR 8.5, 14.5); p = 0.031). Furthermore, children with open fractures had a significantly longer hospital stay (7 days (IQR 5, 9) vs. 3 days (IQR 3, 6); p = 0.001), a higher rate of associated injuries (n = 14 (43.7%) vs. n = 23 (23%); p = 0.022), and a higher rate of postoperative complications (n = 7 (21.9%) vs. n = 8 (8%); p = 0.031). No intraoperative complications were recorded. A total of 15 (11.4%) postoperative complications were recorded. Most complications (60%) were minor complications, mostly related to the wound at the nail insertion site and were managed conservatively. A total of six (4.5%) patients required reoperation due to angulation of the fragments (n = 5) or refracture (n = 1). Conclusion: ESIN is a minimally invasive bone surgery technique and is a highly effective treatment for pediatric tibial unstable fractures with a low rate of complications. Based on the given results, surgical stabilization of the tibial fractures using titanium intramedullary nailing can be safely performed without casting with early physiotherapy

Factors of parenchymal organ injury treatment outcome in children at Department of Pediatric Surgery, Split University Hospital Center during the 2000-2015 period

Cilj ovog rada bio je istražiti čimbenike ishoda liječenja i preživljenje u bolesnika s ozljedom parenhimskih organa trbuha. U vremenskom razdoblju od siječnja 2000. do siječnja 2015. retrospektivno su pregledane povijesti bolesti bolesnika koji su imali traumatsku ozljedu parenhimskih organa. Istražili smo udio bolesnika koji su liječeni operacijski i konzervativno. Zatim smo u obje skupine raščlanili bolesnike na hemodinamski stabilne i nestabilne pri prijmu. Idući korak bila je raščlamba u odnosu na spol, dob, etiologiju, stanje svijesti te na one dovedene u “zlatnom satu” i na one dovedene nakon njega. Izračunali smo ISS (engl. injury severity score) vrijednost, također bodovali težinu ozljede AIS (engl. abbreviated injury scale) vrijednošću te uspoređivali dobivene vrijednosti u odnosu na etiologiju i stanje svijesti, preživljenje i vrijeme dolaska u bolnicu. Istraživanje je obuhvatilo 89-ero bolesnika, od kojih je većina bila muškog spola. Prosječna dob je bila 11 godina. Od ukupnog broja ozlijeđenih udio politraumatiziranih bolesnika iznosio je 50,5%. Bolesnika koji su liječeni transfuzijom krvnih pripravaka bilo je 16 -ero (17,9%). Preživjelo je 88-ero (98,8%) bolesnika. Etio loški je najviše bolesnika stradalo prilikom pada. Slezena je najčešće ozlijeđen organ, uglavnom je posrijedi bila ruptura. AIS i ISS niže su u bolesnika koji su preživjeli te u onih koji su dovedeni u “zlatnom satu” i pri prijmu bili pri svijesti. Na preživljenje utječu hemodinamska stabilnost pri prijmu, AIS i ISS vrijednosti, ozljede ostalih organa u trbušnoj šupljini i ostatku tijela, stanje svijesti pri prijmu, dolazak u “zlatnom satu”. Hemodinamska stabilnost, stanje svijesti i AIS i ISS vrijednosti pokazali su se kao kvalitetni prediktori preživljenja nakon traumatskih ozljeda trbuha.The aim of this study was to determine treatment outcome and survival in patients with blunt abdominal trauma. From January 2000 to January 2015, medical histories of patients treated for traumatic injury of parenchymal organs were retrospectively reviewed and the proportion of patients treated surgically or conservatively was estimated. In both categories, patients were divided into two groups of hemodynamically stable and hemodynamically unstable on admission. The following parameters were analyzed: gender, age, etiology, state of consciousness, and time from injury to admission. Regarding time to admission, patients were divided in those brought within the ‘golden hour’ and those brought beyond it. The Injury Severity Score (ISS) was calculated and the severity of injury assessed by Abbreviated Injury Scale (AIS). The values obtained were compared according to the etiology and state of consciousness, survival, and time to hospital admission. The study included 89 patients, most of them male, average age 11 years. There were 50.5% of polytrauma cases. Sixteen (17.9%) patients were treated with transfusion of blood products. Eighty-eight (98.8%) patients survived. Etiologically, most patients were injured by falling. Spleen was the most commonly injured organ and rupture was the most common type of injury. AIS and ISS were lower in patients brought within the ‘golden hour’ and those that were conscious at admission. The patient who did not survive was hemodynamically unstable, with associated injuries. Survival is infl uenced by hemodynamic stability at admission, AIS and ISS values, injuries of other organs in abdominal cavity and the rest of the body, state of consciousness at admission, and arrival within the ‘golden hour’. Hemodynamic stability, state of consciousness, AIS and ISS values were proved to be good predictors of survival after traumatic injuries of the abdomen

Management of Blunt Pancreatic Trauma in Children

Abstract Purpose. Blunt abdominal trauma is the major cause of abdominal injury in children. Because of the retroperitoneal location, insidious signs and symptoms and the lack of sensitivity with common imaging modalities often lead to diffi culties in making an accurate diagnosis. The most common complication is the formation of a pancreatic fi stula, pancreatitis and a pancreatic pseudocyst, which usually manifests within 3 or 4 weeks after injury. Methods. The case records of seven children (4 male, 3 female) treated for blunt pancreatic injury in the department of pediatric surgery, University Hospital, Split were reviewed. Results. The treatment modalities were selected according to the grade of the pancreatic injury, hemodynamic status and associated injuries. Because all of the patients were classifi ed as grade I or II according to the American Association for the Surgery of Trauma (AAST) classifi cation, a conservative treatment was selected for all seven patients. In four patients the conservative treatment resulted in the total regression of the clinical, biochemical and radiological signs within four weeks (AAST grade I). In the other three patients, pancreatic pseudocysts arose within 3 or 4 weeks after the injury (AAST grade II). Conclusions. The status of the main pancreatic duct and the location of the pancreatic injury constitute the basis of the AAST scoring system. This scale should be used as a guide to selecting a surgical or conservative strategy. Based on these data, two factors appear to be the most important determinants of the treatment strategy for children with pancreatic injury: the grade of the pancreatic injury, which is determined according to the status of the main pancreatic duct and the clinical status of the patient

Factors of esophageal atresia treatment outcome in newborns operated on at Department of Pediatric Surgery, Split University Hospital, during the 1991-2014 period

Atrezija jednjaka je anomalija koja hitnoćom, osjetljivim poslijeoperacijskim vođenjem i potrebom za dugotrajnim liječenjem odskače od ostalih anomalija. Cilj ovog istraživanja je odrediti epidemiološke, demografske i kliničke karakteristike bolesnika operiranih zbog atrezije jednjaka te ih usporediti s ostalim relevantnim studijama. U vremenskom razdoblju od siječnja 1991. do rujna 2014. retrospektivno su pregledane povijesti bolesti 46-ero bolesnika operiranih zbog atrezije jednjaka. Podatke smo prikupili istraživanjem pisanog protokola Zavoda za dječju kirurgiju, Odjela za neonatologiju, JILD-a KBC Split te arhive povijesti bolesti. Svakom ispitaniku analizirani su sljedeći parametri: datum rođenja, spol, tjelesna masa pri porođaju, operacijski zahvat, tip anomalije, preživljenje, rane i kasne komplikacije. Atrezija jednjaka bila je češća kod ispitanika ženskog spola (60%). Najčešći tip atrezije jednjaka prema Vogtovoj klasifi kaciji bio je 3B tip (92%). Ukupni mortalitet iznosio je 35%, uz napomenu da je prije uvođenja intenzivnog poslijeoperacijskog liječenja on iznosio 80%, a nakon uvođenja 14%. Upala pluća bila je najčešća rana komplikacija, dok su najčešće kasne komplikacije bile disfagija (76%) i striktura anastomoze (26%). Kardiovaskularne anomalije su najčešća kongenitalna popratna malformacija i čine 45% svih pridruženih anomalija, a prisutne su u 30% djece s atrezijom jednjaka. Rano prepoznavanje ove anomalije od izuzetnog je značenja, prvenstveno stoga što ona ugrožava život, a rana dijagnoza i operacijski zahvat smanjuju komplikacije te poboljšavaju ishod. Za djetetovo preživljenje nužan je multidisciplinski pristup i prepoznavanje pridruženih anomalija. Osim rane dijagnostike i samog operacijskog zahvata za preživljenje je od presudne važnosti intenzivna poslijeoperacijska skrb.Esophageal atresia is an anomaly that stands out from other anomalies in view of emergency, delicate postoperative treatment and the need for long-term treatment. The aim of this study was to determine epidemiological, demographic and clinical characteristics of patients operated on for esophageal atresia and compare them to other relevant studies. From January 1991 to September 2014, medical histories of 46 patients treated for esophageal atresia were retrospectively reviewed. Data were collected from protocols of the Department for Pediatric Surgery, Department of Neonatology and Intensive Care Unit (ICU), Split University Hospital archives and history of the disease. The following parameters were analyzed: date of birth, sex, birth weight, surgery, type of anomaly, survival, and early and late complications. Esophageal atresia was more frequent in females (60%). The most common type of esophageal atresia according to Vogt classifi cation was type 3B (92%). Overall mortality was 35%, noting that mortality before and after the introduction of ICU care was 80% and only 14%, respectively. Pneumonia was the most common early complication, whereas the most common late complications were dysphagia (35%) and anastomotic stricture (12%). Cardiovascular anomalies were the most common congenital malformations that accounted for 45% of all associated anomalies and found in 30% of the children with esophageal atresia. In conclusion, early recognition of this anomaly is of great importance, primarily due to the fact that it is a life-threatening anomaly the early diagnosis of which and surgery reduce complications and improve the outcome. A multidisciplinary approach and recognition of associated anomalies is necessary for child survival. In addition to early diagnosis, surgical postoperative intensive care is crucial for survival

Pneumoperitoneum in in-vitro Conceived Quadruplet Neonate: Rare Manifestation of Hirschsprungʼs Disease – Report of a Case

Introduction: Hirschsprung’s disease is a congenital colonic aganglionosis, usually presented as inability or difficulty in passing of meconium, chronic and persistent obstipation, maleficent feeding, vomiting, distension and lethargy. Case presentation: We presented a case of an in-vitro conceived quadruplet premature neonate who presented with pneumoperitoneum caused by transverse colon spontaneous perforation and microcolon appearance of distal bowel, treated by resection and temporary colostomy turns to be a rare manifestation of Hirschsprung’s disease. Conclusion: Assisted reproductive technologies increases chances for multiple pregnancies and may increase chance for major congenital anomalies. Rare manifestation of Hirschsprung’s disease is spontaneous pneumoperitoneum which remains a surgical emergency. Delay in recognizing and treatment can significantly worsen prognosis. In neonate with intestinal perforation one should consider Hirschsprung’s disease

Bilateral Simultaneous Testicular Torsion in a Newborn: Report of a Case

Introduction: Testicular torsion is a urological emergency. If not recognized in time, this condition may result in ischaemic injury and loss of testis. Simultaneous bilateral neonatal testicular torsion is extremely rare and is usually misdiagnosed. Case report: We report a case of a male newborn, who presented with bilateral scrotal swelling and redness of the scrotum. Doppler ultrasound supported the diagnosis of bilateral testicular torsion, with an absent blood flow signal on the right side and a weak signal on the left side. Testicular exploration through scrotal incision was performed and bilateral testicular torsion was found. Right testis was grossly gangrenous, and right orchiectomy was performed. Left testicle was dark but showed recovery after detorsion with some bleeding from incised tunica albugenia. Fixation of the left testicle was performed. At six month follow-up, the left testis showed signs of atrophy and hormonal assay showed very low testosterone and elevated LH and FSH, suggesting hypogonadism. Conclusions: Management of neonatal testicular torsion is a matter of controversy. Testicular torsion results into acute ischemia and urgent surgical exploration is the key point of management. Although the possibility of salvaging the involved testicles is usually very low it is hard to justify a passive approach to a bilateral torsion resulting in such a devastating condition as anorchia

Differentiation of inflammatory from non- inflammatory causes of acute scrotum using relatively simple laboratory tests: Prospective study

Abstract Objective: The differential diagnosis of an acute scrotum is of great importance in clinical practice and may be difficult in some cases. The aim of this study was to differentiate inflammatory from non-inflammatory causes of acute scrotum using relatively simple laboratory tests which can be performed quickly and easily outside a hospital setting. Patients and methods: From 2007 to 2010, 85 boys with acute scrotum were included in this prospective study. There were 28 boys with inflammatory and 57 with non-inflammatory causes. We investigated the role of erythrocyte sedimentation rate, Cereactive protein, leukocyte, white blood cell differential count, alkaline phosphatase, creatine kinase and child's age in differential diagnosis of the acute scrotum, differentiating inflammatory from non-inflammatory causes of the disease. We used receiver operating characteristics (ROC) analysis and logistic regression analysis. Results: Statistically significant parameters in accurate differentiation between inflammatory and non-inflammatory causes of the acute scrotum were C-reactive protein (p Z 0.001) and child's age (p < 0.001). These two parameters yielded the probability of an inflammatory outcome in the etiology of acute scrotum with sensitivity of 75% and specificity of 69.1%. Conclusion: Cereactive protein and child's age are helpful in differentiating inflammatory from non-inflammatory causes of the acute scrotum