Termičke promjene tijekom cijeljenja prijeloma distalnoga radijusa [Thermal changes during healing of distal radius fractures]

Bone healing process is very complex. Increase in blood flow around the fracture during the healing process increases the temperature. Infrared thermography is a method of measuring body temperature that can detect thermal changes. A prospective study was conducted on 50 patients with the aim of investigating thermal changes during the healing of distal radius fractures and on 30 healthy volunteers for the purpose of method validation. The Flir ThermaCam B2 (Flir System Inc., Oregon, SAD) was used for all measurements. Thermographic recordings were made at one, three, five, 11 and 23 weeks after fracture. In healthy volunteers, thermographic recordings were made before plaster of Paris immobilization and 24 hours later. The contralateral hand was used for comparison. Patients' x-rays were also analyzed and fracture healing was classified by Hammer and RUSS methods. Significant temperature differences between patients with fractures and healthy volunteers at one, three, five and 11 weeks after the fracture were found, while at 23 weeks there was no temperature difference. The highest temperature differences were at the 3rd week after fracture and then the temperature difference gradually decreased. The dynamics analysis of thermal changes clearly demonstrated the influence of time on temperature changes between broken and healthy hands. Patients with repositioned fractures had a significant difference in temperature relative to those without repositioning and also a lower chance that fracture will heal in five weeks. Patients with a lower temperature difference and a lower drop in temperature had a greater chance of healing. Infrared thermography is a method that is not harmful or invasive and can be used as an additional method of fracture healing follow up in combination with x-ray and clinical examination

Je li skateboard stvarno opasan? – Anketno istraživanje ozljeđivanja skateboardera u Gradu Zagrebu (Is the skateboard really dangerous? – Survey on skateboarding injuries in the City of Zagreb)

Cilj: Opisati strukturu ozljeda zadobivenih pri vožnji skateboarda. Metode: Upitnike o navikama skateboardanja i ozljedama pri vožnji skateboarda popunjavale su muške osobe od 13 do 34 godine, koje su vozile skateboard. Rezultati: Anketom je obuhvaćeno 100 skateboardera. Svi su muškog spola, starosti od 13 do 34 godine. Skateboardingom se bave prosječno 7,5 godina, a skateboard su počeli voziti s 14 godina. 76% ispitanika vozi skateboard 4 puta tjedno ili više. Ukupno su zabilježene 234 ozljede klasificirane kao mild injuries. Sve ozljede dogodile su se na ulici. U vrijeme kad je došlo do ozljede nitko od ispitanika nije nosio nikakav oblik zaštitne opreme. Zaključak: Ozljede su kod skateboardera prisutne, ali se većinom radi o lakšim ozljedama. Težina i učestalost ozljeda dodatno bi se mogle smanjiti korištenjem zaštitne opreme i izgradnjom specijaliziranih skate-parkova.

Molecular characteristics of MRSA strains and patient risk factors in vascular surgery

Methicillin-resistant Staphylococcus aureus (MRSA) is one of the major pathogens in hospitals, and since the 1990s it has been recognized as an important pathogen in community infections. (1) The aim of this study was to analyze MRSA strains from a vascular surgery ward over a five-year period, since the vascular ward is considered to be a high-risk site for different multi-resistant pathogens, among which MRSA is very important. The method used for the microbiological identification and susceptibility testing of strains was the Vitek2 system. For the detailed characterization of the MRSA strains, we used the following molecular methods: SCCmec typing, pulse-field gel electrophoresis (PFGE), spa typing and Panton-Valentine leukocidin (PVL) detection. During the 5-year period, 77 MRSA strains were isolated. Antimicrobial susceptibility: 100% of MRSA isolates were susceptible to oxazolidinones and glycopeptides, 55% were susceptible to gentamycin, and 98% were susceptible to tetracyclines. SCCmec typing: 43 of 77 (55.8%) strains were typed as SCCmec I. The number of isolates with SCCmec II was 28 (36.4%). Three isolates carried SCCmec III. After the PFGE analysis, the isolates were grouped into six similarity groups: A-F. The largest number of isolates (80.6%) belonged to one of two groups: A: 35 (46.8%) and D: 25 (33.8%). Conclusion: The analysis of MRSA strains in the vascular surgery ward revealed high homogeneity among the strains, the majority of which belonged to SCCmec type I. This type, together with the susceptibility profile and PFGE grouping, is considered to be typical of Hospital-Acquired (HA) MRSA

Medical thermography (digital infrared thermal imaging - DITI) in paediatric forearm fractures - a pilot study

Trauma is the most common cause of hospitalisation in children, and forearm fractures comprise 35% of all paediatric fractures. One-third of forearm fractures are distal forearm fractures, which are the most common fractures in the paediatric population. This type of fracture represents an everyday problem for the paediatric surgeon. The three phases of fracture healing in paediatric trauma are associated with skin temperature changes that can be measured and then compared with standard plain radiographs of visible callus formation, and eventually these methods can be used in everyday practice. Thermographic assessment of temperature distribution within the examined tissues enables a quick, non-contact, non-invasive measurement of their temperature. Medical thermography is used as a screening method in other parts of medicine, but the use of this method in traumatology has still not been researched

Analiza prašine nastale piljenjem sadrenih udlaga

Plaster splints are used daily in surgical and orthopedic fields in order to immobilize injured children and adults. The aim of this study was to measure the aerodynamic diameter and concentration of dust particles in the air caused by sawing plaster splints (calcium sulfate dehy-drate). We performed fractional measurements of airborne dust particles. The measured particles, which can potentially be inhaled, may have a specific negative effect on human health. Measurements were conducted in laboratory research facilities that simulated hospital conditions within a casting room and the associated waiting room. Measurements within the casting room were made using two particle collector devices and one laser photometer. The measurement for the simulated waiting room was performed using the same principles and devices. The collected plaster dust particles differed in aerodynamic diameter and concentration according to the various locations observed. The highest concentration of particles of all sizes was recorded at the site of cast sawing. There was direct correlation between distance from the source and concentration of airborne particles; this concentration was lowest in the waiting room. The concentrations of plaster dust recorded were lower than the recommended minimal limit values for total and respiratory fractions in Croatia. Accordingly, it can be assumed that sawing of plaster splints has no harmful health effects on the exposed patients and health personnel.Sadrene udlage se svakodnevno rabe u kirurškoj i ortopedskoj praksi prilikom imobilizacije ozlijeđene djece i odraslih. Cilj ovoga rada bio je izmjeriti aerodinamički promjer i koncentraciju čestica prašine u zraku nastale piljenjem sadrenih udlaga (kalcijev sulfat dihidrat). Učinjeno je frakcionirano mjerenje lebdećih čestica prašine. Izmjerene frakcije, ovisno o respirabilnosti čestica, mogu imati određeno negativno djelovanje na ljudsko zdravlje. Mjerenja su provedena u laboratorijskim uvjetima, uz simulaciju bolničkih prostorija gipsaonice i njene čekaonice. Mjerenja u gipsaonici izvršena su pomoću dva para sakupljača čestica i jednog laserskog fotometra. Mjerenje u čekaonici provedeno je na jednak način. Prikupljena prašina po mjernim mjestima razlikuje se po aerodinamičkom promjeru i koncentraciji čestica gipsa u zraku. Najviše koncentracije čestica svih veličina zabilježene su neposredno uz mjesto piljenja. Na ostalim mjernim mjestima koncentracija čestica opada s udaljenošću od izvora prašine pri čemu je koncentracija prašine bila najniža u čekaonici. Zabilježene koncentracije prašine gipsa niže su od propisanih graničnih vrijednosti za ukupnu i respiracijsku frakciju u Hrvatskoj. Na temelju toga razumno je pretpostaviti da za vrijeme piljenja sadrenih udlaga nema štetnog učinka na zdravlje izloženih bolesnika i zdravstvenog ­osoblja

Prijelomi bedrene kosti u djece – okolnosti i uzroci nastanka [Femur fractures in children – causes and mechanisms of injury]

Children are often exposed to injuries due to their hyperactivity. Femur fractures can however leave permanent consequences despite adequate treatment. The high prevalence and possible invalidity justify research in the field of prevention of this injury. But prevention is possible only by knowing the causes and circumstances of the fractures. The aim of this research is to analyze the circumstances and places of occurrence in femur fractures according to children age groups. This retrospective study includes 103 children up to the age of 18 years treated at the University Hospital Center of Medicine Zagreb, or at the Clinic for children diseases Zagreb in the period from 2012 to 2016. The study includes 35 (33 %) girls and 71 (67 %) boys, a total of 106 children with femur fractures. The average age was five years. The majority of the injured children, 52 children (55,2 %), belonged to the youngest age group from 0 to 4 years of age. Diaphysis fractures were the most common with 66 fractures (62 %), and the rarest were fractures of the distal metaphysis with 15 fractures (13 %). The fractures occurred at home in 41 cases (38 %), in the street in 38 cases (36 %), at recreation in 22 cases (21 5), and at school or kindergarten in 3 cases (3 %). The most common causes of femur fractures were falls in 38 cases (57,5 %), motor vehicle accidents in 35 cases (33 %), and crashes and blows in 10 cases (9,5 %). One third of the children with femur fractures had associated injuries, and four fifths of them were caused by motor vehicle accidents. The results of this study show that femur fractures are most frequent in the youngest age groups, and are generally a consequence of accidents at home (mostly falls), seldom in the streets or recreational places. Parents of preschool children should be educated about prevention of falling at their homes, and parents of school children should be educated about the dangers of fractures at recreational places and traffic

Prijelomi distalnog radijusa u djece – uzroci i mjesta nastanka [Distal radius fractures in children – causes and places of occurrence]

Distal radius fractures are the most common fractures in children and account for about 25% of all fractures. The main mechanism of occurrence is a fall on the outstretched hand. These fractures usually occur as a result of accidents, and rarely because of injuries and pathological conditions. In this retrospective study, we analyzed 182 hospital-treated distal radius fractures, of which 61 fractures (29.8%) represent epiphysiolysis. The causes are divided into three groups: fall 124 (68.1%), injuries in traffic 50 (27.5%), and strikes 8 (4.4%). Falls usually occur during sport or game playing 72 (39.6%), and traffic injuries occur during cycling 30 (52%) and roller skating 25 (43%). Children were most often injured in the areas of sports and recreational activities 115 (63%), on the street 38 (21%), and at the school 16 (9%). In our children the highest incidence of distal radius fractures was during sports and recreational activities, and the lowest in school and at home

AMBULATORY PROCEDURES IN DAY SURGERY DEPARTMEN

Jednodnevna i ambulantna kirurgija dva su modaliteta izvanbolničkog liječenja koje se provodi u dnevnoj kirurškoj bolnici. Svrha ovog istraživanja, provedenog u Dnevnoj bolnici Kirurške klinike, bila je prikupiti i analizirati pokazatelje strukture bolesnika, dijagnoza, učinjenih zahvata i organizacije ambulantne kirurgije. Studija analizira 3409 ambulantnih kirurških zahvata i histoloških dijagnoza odstranjenog tkiva kod 2736 bolesnika (1457 ženskog i 1279 muškog spola). Specijalist dermatolog uputio je 408 (14,9%) bolesnika, a ostali su došli prema preporuci liječnika primarne zdravstvene zaštite. Prema uputnoj dijagnozi, benigne promjene imala su 2522 (92%) bolesnika, displastične 47 (2%), a maligne njih 167 (6%). Prosječna životna dob bila je 52,8 godina. Bolesnici s benignom novotvorinom bili su znatno niže prosječne dobi (44,2) od onih s malignom (66,5). Najčešća uputna dijagnoza bila je D22 – melanocitni madež. Od ukupno 38, deset najčešćih čini 87% svih uputnih dijagnoza. Prema 10. reviziji Međunarodne klasifikacije bolesti (MKB-10), to su: D22 (33,9%), D23 (21,3%), D21 (13,4%), D17 (6,9%), D21.0 (3,2%), C44 (2,4%), D21.1 (1,7%), L02 (1,6%), L08 (1,6%) i B07 (1,3%). Od kirurških postupaka najčešće su izvođeni ekstirpacija, ekscizija i biopsija pigmentne promjene ili novotvorine kože. Kada su ambulantni zahvati rađeni zbog sumnje na benignu bolest, patohistološka je dijagnoza potvrdila 94,6% uputnih i samo 48% sumnji na malignu novotvorinu. Od bolesnika upućenih s dijagnozom benigne novotvorine 114 (4,5%) imalo je maligni tumor kože. Malignih novotvorina ukupno je bilo 219 (8,0%), a melanoma 24 (0,8%). Od ukupno 16 anatomskih regija ljudskog tijela tri čine 56% svih lokalizacija izvođenja zahvata. To su leđa (750), glava (520) i prsište (260). Zahvate je radilo dvadeset i dvoje liječnika različitih specijalizacija, najčešće specijalisti opće kirurgije (64,2%). Specijalisti plastične i rekonstruktivne kirurgije ukupno su operirali 458 (16,0%) bolesnika. Dječji kirurzi operirali su 381 (13,9%), a ostali 130 (4,8%) bolesnika. Ambulantna je kirurgija kirurgija kože, potkožja i mekih tkiva koja su redovito zahvaćena benignim tumorima ili pigmentnim promjenama, pretežito lokaliziranim na trupu i glavi. Samo je 43,8% bolesnika s dokazanim malignitetom bilo klinički prepoznato, što uz veću pojavnost malignih histoloških (8%) nego uputnih dijagnoza (6%) upućuje da dobar dio bolesnika nije prošao temeljit dijagnostički postupak.Day surgery and ambulatory surgery are two modalities of outpatient treatment carried out in day surgery department in Croatia. The purpose of this study, conducted in day surgery department, was to collect and analyze indicators of patient structure, diagnoses, performed procedures and organization of ambulatory surgery. This study analyzes 3409 ambulatory procedures and histological diagnoses of removed tissue in 2736 patients (1457 female and 1279 male). The indications for treatment were in 408 (14.9%) cases set by dermatologists while others were referred by primary healthcare physicians. According to the referral diagnosis, 2522 (92%) patients had benign, 47 (2%) dysplastic, and 167 (6%) malignant changes. The average patient age was 52.8 years. Patients with benign changes were, in average, significantly younger (44.2) than those with malignant ones (66.5). The most common referral diagnosis was D-22 melanocytic nevus. From a total of 38, 10 most common diagnoses constitute 87% of all referral diagnoses. According to International Classification of Diseases, Tenth Edition (ICD-10), these are: D22 (33.9%), D23 (21.3%), D21 (13.4%), D17 (6.9%), D21.0 (3.2%), C44 (2.4%), D21.1 (1.7%), L02 (1.6%), L08 (1.6%), B07 (1.3%). The main surgical procedures include extirpation, excision and biopsy of pigmented changes or skin neoplasms. When a procedure was performed because of a suspected benign lesion, pathohistological diagnosis confirmed 94.6% of such referral diagnoses as benign, whereas only 48% of clinically suspected malignant neoplasms were pathohistologically malignant. Out of patients referred with a clinically diagnosed benign lesion, 114 (4.5%) patients had a pathohistologically confirmed malignant skin tumor. The total number of malignant neoplasms was 219 (8.0%), and of melanoma 24 (0.8%). Out of 16 anatomical regions of the human body surgical procedures performed in three localizations make 56% of all localizations of performed procedures. These are: back (750), head (520) and chest (260). The procedures were performed by 22 physicians of various specialties, mostly by general surgeons (64.2%). Plastic and reconstructive surgeons performed 458 (16%), pediatric surgeons 381 (13.9%) and others 130 (4.8%) procedures. Ambulatory surgery is the surgery of skin, subcutaneous and soft tissue, usually affected by benign tumors or pigmentary changes, located mostly on the head and trunk. Only 43.8% of patients with verified malignancy were clinically recognized, which indicates, along with the higher incidence of malignancy in pathohistological (8%) than referral (6%) diagnoses, that a significant number of patients did not undergo a thorough diagnostic procedure

Fizikalna svojstva sadrenih zavoja [Physical properties of plaster bandages]

The physical properties of plaster bandages are a very important factor in achieving the basic functions of immobilization (maintaining bone fragments in the best possible position), which directly affects the speed and quality of fracture healing. This paper compares the differences between the physical properties of plaster bandages (mass, specific weight, drying rate, elasticity and strength) and records the differences in plaster modeling of fast bonding 10 cm wide plaster bandages, from three different manufacturers: Safix plus (Hartmann, Germany), Cellona (Lohman Rauscher, Austria) and Gipsan (Ivo Lola Ribar ltd., Croatia). Plaster tiles from ten layers of plaster, dimension 10 x 10 cm were made. The total number of tiles from each manufacturer was 48. The water temperature of 22 °C was used for the first 24 tiles and 34 'C was used for the remainder. The average specific weight of the original packaging was: Cellona (0.52 g/cm3), Gipsan (0.50 g/cm3), Safix plus (0.38 g/cm3). Three days after plaster tile modeling an average specific weight of the tiles was: Gipsan (1.15 g/cm3), Safix plus (1.00 g/cm3), Cellona (1.10 g/cm3). The average humidity of 50% for Safix plus and Cellona plaster tiles was recorded 18 hours after modeling, while for the Gipsan plaster tiles, this humidity value was seen after 48 hours. On the third day after plaster modeling the average humidity of the plaster tiles was 30% for Gipsan, 24% for Safix and 16% for Cellona. Cellona plaster tiles made with 34 °C water achieved the highest elasticity (11.75±3.18 MPa), and Gipsan plaster tiles made with 22 °C had the lowest (7.21±0.9 MPa). Cellona plaster tiles made with 34 °C water showed maximum material strength (4390±838 MPa), and Gipsan plaster tiles made with 22 °C water showed the lowest material strength (771±367 MPa). The rigidity and strength of Cellona and Gipsan plaster are higher in tiles made in warmer water, and for Safix plus are higher in tiles made in cooler water. All three types of plaster differentiate in physical properties. The differences in mass and specific weight before and after plaster modeling are minimal. There are greater differences in drying rate, elasticity and strength between the three different plaster materials