Radiografska analiza odnosa lateralnog interkondilarnog grebena s Blumensaatovom linijom i tangentom stražnjeg femoralnog kortikalisa

The aim of this study is to determine the radiographic position of the lateral intercondylar ridge (LIR) and its relationship with the Blumensaat line (BL) and the tangent to the posterior cortex (PCT) of the distal femur. On 35 femur specimens, the LIR was labeled by using a 1 gauge wire. A true lateral view with the distal femur was taken. On the taken plain radiographs, we measured angles that close between BL and LIR, PCT and LIR. We also measured the ratio in which LIR crosses the BL. The mean angle between BL and LIR was 70,130 (SD 12,690), and the mean angle that BL closes with PCT was 143,610 (SD 7,910). The point where LIR intersects the BL divides it in a 1:6 ratio. Using these radiological measurements will allow surgeons to quickly estimate the position of the LIR and also allow quick and convenient preoperative planning, intraoperative tunnel placement as well as postoperative analysis.Cilj ove studije je odrediti radiografski položaj lateralnog interkondilarnog grebena (LIR) u odnosu na Blumensaatovu liniju (BL) i tangentu stražnjeg kortikalisa (PCT) femura. Na 35 preparata femura lateralni interkondilarni greben označili smo bakrenom žicom debljine 1 mm. Na pravim postraničnim radiografskim snimkama femura odredili smo kut koji zatvaraju BL i LIR, te LIR i PCT. Također smo izračunali omjer u kojem LIR dijeli BL. Prosječni kut koji zatvaraju BL i LIR iznosi 70,130 (SD 12,690), a prosječan kut između BL i PCT 143,610 (SD 7,910). Točka u kojoj LIR sječe BL dijeli liniju u omjeru 1:6. Predloženom radiografskom metodom moguće je pouzdano odrediti položaj LIR-a što će omogućiti lakše planiranje zahvata, lakše i točnije postavljenje femoralnog tunela kao i poslijeoperacijsku analizu

Readiographic analysis of the Blumensaat’s line and the location of the lateral intercondylar ridge as contribution to the anatomic anterior cruciate ligament reconstruction

Cilj: Cilj rada bio je ispitati oblik Blumensaatove linije te utvrditi položaj lateralnog interkondilarnog grebena u odnosu na nju. Ispitanici i metode: U radu je korišteno 12 preparata femura sa Zavoda za anatomiju Medicinskog fakulteta u Rijeci. Na svakom preparatu tankom savitljivom žicom obilježen je lateralni interkondilarni greben. Učinjena je postranična rendgenska snimka femura uz potpuno preklapanje kondila. Na snimkama je analiziran oblik Blumensaatove linije, razlika u rendgenološkoj gustoći prikaza pojedinih dijelova te položaj lateralnog interkondilarnog grebena u odnosu na Blumensaatovu liniju. Rezultati: Na rendgenološkom prikazu Blumensaatova linija bila je ravna u 25 % preparata. U 75 % preparata stražnji dio linije bio je konveksan u smjeru prema distalno. S obzirom na radiografsku gustoću Blumensaatove linije mogla se podijeliti u tri dijela. Prednji i stražnji dio imali su gustoću intenziteta kortikalne kosti, dok je gustoća srednjeg dijela odgovarala intenzitetu spongiozne kosti. Lateralni interkondilarni greben spaja se s Blumensaatovom linijom u točki koja stražnji segment dijeli u omjeru 58 % : 42 %. Lateralni greben s Blumensaatovom linijom zatvara kut od 62.40 stupnjeva. Zaključak: Blumensaatova linija u 75 % analiziranih preparata nije ravna, već je u stražnjem dijelu zaobljena s konveksitetom usmjerenim prema distalno. Na profilnoj RTG snimci LIR koljena zatvara kut od 62.40 stupnjeva.Aim: The aim of this study was to analyze the shape of the Blumensaat\u27s line and the relationship with lateral intercondylar ridge on the lateral radiographic view. Patients and Methods: On twelve femoral specimens, the lateral intercondylar ridge were labeled with the thin wire. A full lateral view with the distal femur was taken. At the X-ray we analyzed the radiographic shape of the Blumensaat’s line and a possible difference of the radiographic density during its course. The angle between lateral intercondylar ridge and Blumensaat’s line was calculated as well. Results: The Blumensaat’s line was straight in 25% of specimens. In 75% the posterior part had convexity. Regarding the radiographic density the BL could be divided into three parts. The density of the anterior and posterior was similar as the cortical bone, while the middle part corresponds to the cancellous bone. The posterior part was the longest. The lateral intercondylar ridge and the Blumensaat’s line formed the angle of average 62,40 and intersect with the LIR at the point which divides the posterior part of the BL at the 58%:42% ratio. Conclusion: In 25% the Blumensaat’s line was straight. In 75% of the specimens the posterior convexity was observed. The lateral interc ondylar ridge and the Blumenssat’s line formed the angle of the 62,50. They intersected at the point which divides the posterior part in the 58:42 ratio

Lateral retinaculum: past and present

Povećana napetost lateralnog retinakula patele može se javiti kao samostalni entitet ili u sklopu drugih poremećaja patelofemoralnog zgloba kao što su patelofemoralna displazija, lateralna nestabilnost patele, ozljede medijalnog patelofemoralnog ligamenta i hondromalacija. Presijecanje lateralnog retinakula, kako bi se postigao bolji balans aktivnih i pasivnih stabilizatora patele i na taj način korigirao njen položaj, bila je jedna od najizvođenijih operacija u ortopediji bez obzira na etiologiju poremećaja. Biomehaničke i kliničke analize pokazale su mogućnost nastanka brojnih komplikacija koje mogu nastati neselektivnom primjenom ove operacijske tehnike od kojih je najteža medijalna nestabilnost patele. Danas se kao metoda za korigiranje napetosti lateralnih stabilizatora patele češće upotrebljava tehnika produljivanja lateralnog retinakula kojom se puno bolje može regulirati napetost lateralnih struktura uz značajno manje komplikacija.Tightness of the lateral patellar soft tissue complex could be isolated entity or associated with other patellofemoral disorders such as patellofemoral dysplasia, lateral patella instability, medial patellofemoral ligament injury and chondromalatia. Lateral retinacular release was a method of choice among orthopaedic surgeons for improving the patellofemoral balance and congruency regardless the etiology of patellofemoral disorders. Biomechanical and clinical studies have shown that nonselective use of this surgical method could cause numerous complications among which medial patellar instability is the worst. Today most orthopaedic surgeons prefer lengthening instead release, because lateral lengthening is a more precise technique, with reduced complication rates

Correction of adult posttraumatic rigid severe pes equinovarus with tibiotalocalcaneal retrograde nailing

Uvod: Liječenje zapuštenih slučajeva posttraumatskog pes equinovarusa u odrasloj dobi veoma je zahtjevno. Radi se o rigidnim deformacijama stražnjeg dijela stopala koje su popraćene uznapredovalim osteoartrotskim promjenama. U korekciji deformiteta potrebna je primjena kombinacije koštanih i mekotkivnih zahvata. Prikaz slučaja: U ovom radu prikazano je liječenje posttraumatskog deformiteta stopala s varusom gležnja od 40Introduction: Neglected pes equinovarus deformity at the adulthood is difficult to correct. It is usually a rigid deformity associated with arthritic changes of the hindfoot joint. Combined bone and soft tissue procedure is necessary to correct the deformity. Case report: We present a case of acquired severe rigid pes equinovarus in adulthood with varus ankle of 4

History of hip arthroplasty: From John R. Barton to John Charnley

Totalna endoproteza kuka smatra se najrevolucionarnijim zahvatom u ortopediji koji je u cijelosti promijenio način liječenja artrotski promijenjenih zglobova kuka, a imala je i velik utjecaj na razvoj liječenja ostalih zglobova. U radu je opisan povijesni razvoj totalne endoproteze kuka, od prvih pokušaja u liječenju artrotičnih zglobova kuka.he total hip arthroplasty is considered to be one of the most successful orthopedic interventions of its generation, and it completely changed the way of treatment of arthritic hip. It also had great influence on treatment of other joints. Hearwith we described the history of total hip arthroplasty from the first attempts to treat a painful and arthritic hip

Tibial tubercle avulsion fracture with concomitant reversibile foot paresis in adolescent

Cilj: Cilj rada bio je prikazati da i manje traume u adolescentno doba mogu uzrokovati avulziju tuberositasa tibije te ukazati na mogućnost nastanka kompartment sindroma. Prikaz slučaja: Kod dječaka u dobi od 15 godina pri promjeni smjera kretanja došlo je do avulzije tuberositasa tibije. Ozljeda je popraćena velikim edemom. Nakon operacije razvila se pareza peronealnog živca koja je uz medikamentoznu i fizikalnu terapiju regredirala u cijelosti. Zaključak: Pri sumjnji na avulziju tuberositasa tibije potrebna je žurna dijagnostika i liječenje. Zbog mogućeg nastanka sindroma kompartmenta potreban je pojačan nadzor u perioperacijskom periodu.Aim: to show that even a minor trauma could cause the tibial tubercle avulsion in adolescents and has a high risk of developing compartment syndrome. Case report: A boy aged 15 sustained tibial tubercle avulsion after a minor trauma. During the postoperative period the peronal paresis was observed which regressed on pharmaceutical and physical therapy. Conclusion: Early recognition and treatment of tibial tubercle avulsion is very important. Close monitoring during the perioperative period is recommended

Subbrachial approach to humeral shaft fractures: new surgical technique and retrospective case series study

BACKGROUND: There are few surgical approaches for treating humeral shaft fractures. Here we present our results using a subbrachial approach. METHODS: We conducted a retrospective case series involving patients who had surgery for a humeral shaft fracture between January 1994 and January 2008. We divided patients into 4 groups based on the surgical approach (anterior, anterolateral, posterior, subbrachial). In all patients, an AO 4.5 mm dynamic compression plate was used. RESULTS: During our study period, 280 patients aged 30- 36 years underwent surgery for a humeral shaft fracture. The average duration of surgery was shortest using the subbrachial approach (40 min). The average loss of muscle strength was 40% for the anterolateral, 48% for the posterior, 42% for the anterior and 20% for the subbrachial approaches. The average loss of tension in the brachialis muscle after 4 months was 61% for the anterolateral, 48% for the anterior and 11% for the subbrachial approaches. Sixteen patients in the anterolateral and anterior groups and 6 patients in the posterior group experienced intraoperative lesions of the radial nerve. No postoperative complications were observed in the subbrachial group. CONCLUSION: The subbrachial approach is practical and effective. The average duration of the surgery is shortened by half, loss of the muscle strength is minimal, and patients can resume everyday activities within 4 months. No patients in the subbrachial group experienced injuries to the radial or musculocutaneous nerves

Ankle syndesmosis: anatomy, mechanisms of injuries, diagnosis and treatment

Distalni tibiofibularni zglob odgovoran je za širinu i stabilnost takozvane zglobne viljuške gležnja koju sačinjavaju distalna tibija i distalna fibula. Prema nekim autorima tijekom uganuća gležnja u 95 % slučajeva dolazi i do ozljede ligamenta distalnog tibiofibularnog zgloba. Upravo je prepoznavanje ovih ozljeda od velike važnosti, jer se pacijenti s tim ozljedama liječe dvostruko dulje od pacijenata s ozljedama ligamentarnih struktura lateralne strane gležnja, a do povratka sportskim aktivnostima protekne i do 6 mjeseci. Standardni klinički testovi i klasične rendgenske snimke nisu često dostatni za postavljanje dijagnoze, pa je pri sumnji na ozljede sindezmoze potrebno učiniti i magnetsku rezonanciju. Način liječenja akutnih izoliranih ozljeda sindezmoze ovisi o stupnju nestabilnosti gležnja. Danas još uvijek postoje nedoumice i nesuglasja u postavljanju dijagnoze i liječenja takvih ozljeda. U ovom radu pokušali smo na sistematičan način prikazati anatomske karakteristike distalnog tibiofibularnog zgloba, ali i najnovije stavove u dijagnostici i liječenju ozljede sindezmoze.Distal tibiofibular joint is responsible for the distal crucial anatomic structure responsible for the ankle joint stability. According to some authors syndesmosis injury occurs in 95% of the lateral ankle sprain during sport activity. Syndesmotic injuries often require twice as long to return to sport as compared to isolated lateral ligament sprains and can lead to prolonged pain and disability. Clinical tests and plain radiography have limited diagnostic capacity and often MRI imaging is necessary. The treatment of the acute isolated syndesmotic injury depends on the ankle stability. Today still, there is some doubt and disagreement regarding diagnostic criteria, classification, and treatment of syndesmotic injury

MECHANISMS OF JOINT DESTRUCTION IN OSTEOARTHRITIS

OA je najčešći oblik artritisa i jedan od glavnih uzroka boli i smanjene pokretljivosti pogotovo u starijoj populaciji. OA je rezultat složenog procesa abnormalnog remodeliranja zglobnih struktura kojoj posreduje i veliki broj upalnih medijatora. Velik je broj rizičnih čimbenika, poput dobi, spola, pretilosti, prethodne ozljede zgloba, genetske predispozicije, mehaničkih čimbenika kao što je nekongruentnost zgloba. Svi zglobovi koji su zahvaćeni s OA, neovisno o mehanizmu, pokazuju slične promjene poput degeneracije hrskavice, zadebljanja subhondralne kosti, formiranja osteofita, upale sinovijalne membrane, degeneracije ligamenata, a u koljenu i degeneracije meniska, hipertrofije zglobne kapsule. Zglobna hrskavica igra ključnu ulogu u patogenezi i progresiji OA, a na njoj se prvo uočavaju oštećenja. Promjene koje se javljaju na kostima rezultat su njene dinamičke adaptacije na biomehaničke sile i učinke solubilnih čimbenika koji se nalaze unutar zgloba zahvaćenog s OA. Sinovijalna membrana i sinovijalna tekućina prožete su upalnim stanicama i zbog toga gube svoju sposobnost zaštite zgloba. Citokini su ključni u patogenezi OA, a najviše je istražena uloga IL-1, TNF-, IL-6, IL-15, IL-17 i adipokina.OA is the most common form of arthritis and one of the main causes of pain in elder population. OA is the result of a complex process of abnormal remodelling of the articular structures. There are many risk factors such as: age, gender, obesity, injury, genetics, joint malalignment. All joints that are affected with OA, regardless of the mechanism, show similar pathological changes: cartilage degeneration, thickening of the subhondral bone, osteophytes formation, synovial membrane inflammation, degeneration of the ligaments and meniscs in the knee and joint capsule hypertrophy. The articular cartilage plays a major role in the pathogenesis and progression of OA and it is the first structure in which changes can be detected. Changes on the bone are the result of its dynamic adaptation to biomechanical forces and effects of solubile inflammatory mediators induced in OA affected joints. Synovial membrane and the synovial fluid are also infiltrated with inflammatory cells which results in the loss of its protective properties. Cytokines that are crucial in the pathogenesis of OA are IL-1, TNF-, IL-6, IL-15, IL-17 and adipokines

MECHANISMS OF JOINT DESTRUCTION IN OSTEOARTHRITIS

OA je najčešći oblik artritisa i jedan od glavnih uzroka boli i smanjene pokretljivosti pogotovo u starijoj populaciji. OA je rezultat složenog procesa abnormalnog remodeliranja zglobnih struktura kojoj posreduje i veliki broj upalnih medijatora. Velik je broj rizičnih čimbenika, poput dobi, spola, pretilosti, prethodne ozljede zgloba, genetske predispozicije, mehaničkih čimbenika kao što je nekongruentnost zgloba. Svi zglobovi koji su zahvaćeni s OA, neovisno o mehanizmu, pokazuju slične promjene poput degeneracije hrskavice, zadebljanja subhondralne kosti, formiranja osteofita, upale sinovijalne membrane, degeneracije ligamenata, a u koljenu i degeneracije meniska, hipertrofije zglobne kapsule. Zglobna hrskavica igra ključnu ulogu u patogenezi i progresiji OA, a na njoj se prvo uočavaju oštećenja. Promjene koje se javljaju na kostima rezultat su njene dinamičke adaptacije na biomehaničke sile i učinke solubilnih čimbenika koji se nalaze unutar zgloba zahvaćenog s OA. Sinovijalna membrana i sinovijalna tekućina prožete su upalnim stanicama i zbog toga gube svoju sposobnost zaštite zgloba. Citokini su ključni u patogenezi OA, a najviše je istražena uloga IL-1, TNF-, IL-6, IL-15, IL-17 i adipokina.OA is the most common form of arthritis and one of the main causes of pain in elder population. OA is the result of a complex process of abnormal remodelling of the articular structures. There are many risk factors such as: age, gender, obesity, injury, genetics, joint malalignment. All joints that are affected with OA, regardless of the mechanism, show similar pathological changes: cartilage degeneration, thickening of the subhondral bone, osteophytes formation, synovial membrane inflammation, degeneration of the ligaments and meniscs in the knee and joint capsule hypertrophy. The articular cartilage plays a major role in the pathogenesis and progression of OA and it is the first structure in which changes can be detected. Changes on the bone are the result of its dynamic adaptation to biomechanical forces and effects of solubile inflammatory mediators induced in OA affected joints. Synovial membrane and the synovial fluid are also infiltrated with inflammatory cells which results in the loss of its protective properties. Cytokines that are crucial in the pathogenesis of OA are IL-1, TNF-, IL-6, IL-15, IL-17 and adipokines