Orthogeriatrics – considerations in caring for older orthopaedic patient

Patients over the age of 65 are the fastest growing segment of the population, and it is estimated that it comprises 12.5% of the entire population in the developed countries. Advances in medicine, science and healthy lifestyles have promoted substantially increased lifespans, aswell as better quality of life with more physical activity. On the other hand, aging is associated with a variety of physiologic changes that affect orthopedic care. Due to natural involution processes older adults may not have the physiologic reserves necessary to promote healing or to prevent or recover fromcomplications. Degenerative diseases and injuries sustained from trauma in combination with physiologic changes and comorbidity in the aged pose a significant health problem in older adults and a major treatment challenge for an orthopaedic surgeon. This review summarizes some of these unique challenges in care for older orthopaedic patient

Osteogenesis imperfecta - multi-systemic and life-long disease that affects whole family [Osteogenesis imperfecta - više-sustavna, doživotna bolest i njen utjecaj na obitelj]

Osteogenesis imperfecta or brittle bone disease, a heritable disorder of connective tissue, is the most common of the inherited disorders primarily affecting bone. There are approximately 400 individuals with OI in Croatia alone. It is estimated that twice that number is present, represented by individuals with mild OI in whom the diagnosis has not been made. Due to the relatively low number of patients in the general population, treating physicians have limited experience with this disease, either with children or adults. The basis of this disease in European populations is mostly the result of defects in the structure or processing of collagen type I, an important protein of the extracellular matrix of many tissues. Presently, molecular defects in 16 different genes have been discovered to result in at least one type of OI of which 14 are not COL1 mutation loci. Although fractures occurring with no injury or minor injury are the hallmark of OI, other non-mineralized tissues can be affected as well and the pathological changes can be present in skin, tendons, eyes, teeth and blood vessels. Clinical manifestations are very heterogeneous and numerous signs and symptoms such as blue sclera, deafness, abnormal teeth development, joint hypermobility, increased risk of hernias, capillary fragility, aneurysms etc. Although there is no cure for this disease, there are specific therapies that can reduce the pain and complications associated with OI. The purpose of this review is to provide a brief overview of the molecular basis of this disease, describe clinical presentations, as well as to present orthopaedic therapeutic modalities for the patients with OI

Lezije koštane srži: koncept dvaju stupova

A common magnetic resonance imaging pattern of bone marrow lesion has been described in numerous pathological entities. However, despite intensive research, its etiopathological pathways and repercussions on disease progression remain controversial. From our current knowledge, subchondral bone represents an active site of remodelling fulfilling both mechanical and biological joint requirements. Alteration of bone remodelling activity, as one of the major characteristics of bone marrow lesions, can potentially lead to biological and structural impairment of the affected tissue and consequently the entire joint. The discovered close connection between subchondral bone biology and its structural changes together with parallel changes in overlying cartilage is setting the scene for a potentially new concept. In this “Two Pillar“ concept both structure and biology of subchondral bone (and its biomechanical and biochemical interference with the layer above) represent the foundations of the structure and function of articular cartilage. In light of the proposed concept, we will review current knowledge on aetiology, pathogenesis, and clinical presentation of BML and correlate it to existing and emerging treatment options.Uobičajeni prikaz lezija koštane srži na magnetskoj rezonanciji opisan je u brojnim patološkim entitetima. Međutim, unatoč intenzivnim istraživanjima, njegovi etiopatološki putevi i posljedice na progresiju bolesti ostaju kontroverzni. Prema našim trenutnim spoznajama, subhondralna kost predstavlja aktivno mjesto remodeliranja s važnom mehaničkom i biološkom ulogom u održavanju homeostaze zglobova. Promjene remodeliranja kosti, kao jedna od glavnih karakteristika lezije koštane srži, može potencijalno dovesti do biološkog i strukturnog oštećenja zahvaćenog tkiva i posljedično cijelog zgloba. Otkrivena bliska veza između biologije subhondralne kosti i njezinih strukturnih promjena, zajedno s paralelnim promjena ma u hrskavici koja se nalazi iznad, postavljaju scenu za potencijalno novi koncept. U ovom konceptu “Dva nosiva stupa” i struktura i biologija subhondralne kosti (i njezina biomehanička i biokemijska interferencija sa slojem iznad) predstavljaju temelje strukture i funkcije zglobne hrskavice. U svjetlu predloženog koncepta osvrnuti ćemo se na trenutne spoznaje o etiologiji, patogenezi i kliničkoj prezentaciji lezija koštane srže te ih povezati s postojećim i novim mogućnostima liječenja

Osteogenesis Imperfecta – Multi-Systemic and Life-Long Disease that Affects Whole Family

Osteogenesis imperfecta or brittle bone disease, a heritable disorder of connective tissue, is the most common of the inherited disorders primarily affecting bone. There are approximately 400 individuals with OI in Croatia alone. It is estimated that twice that number is present, represented by individuals with mild OI in whom the diagnosis has not been made. Due to the relatively low number of patients in the general population, treating physicians have limited experience with this disease, either with children or adults. The basis of this disease in European populations is mostly the result of defects in the structure or processing of collagen type I, an important protein of the extracellular matrix of many tissues. Presently, molecular defects in 16 different genes have been discovered to result in at least one type of OI of which 14 are not COL1 mutation loci. Although fractures occurring with no injury or minor injury are the hallmark of OI, other non-mineralized tissues can be affected as well and the pathological changes can be present in skin, tendons, eyes, teeth and blood vessels. Clinical manifestations are very heterogeneous and numerous signs and symptoms such as blue sclera, deafness, abnormal teeth development, joint hypermobility, increased risk of hernias, capillary fragility, aneurysms etc. Although there is no cure for this disease, there are specific therapies that can reduce the pain and complications associated with OI. The purpose of this review is to provide a brief overview of the molecular basis of this disease, describe clinical presentations, as well as to present orthopaedic therapeutic modalities for the patients with OI

Stem cells in bone regeneration

Bone defects, including normal fracture healing as well as healing problems represent a global health problem. The need for better treatment of bone defects is one of the central issues of tissue engineering and regenerative medicine. Regenerative orthopedics has several approaches – activation of endogenous stem cells, stem cell therapy and tissue engineering. Development of new treatments is mainly focused on the tissue engineering strategies that include stem cells, bioactive signals and appropriate scaffold support. The aim of this review is to describe a variety of stem cells that have an ability to become bone cells and therefore are of central importance for bone tissue engineering. Several cell types have been proposed as starting material - embryonic stem cells, induced pluripotent stem cells and adult stem cells. Due to ethical and safety issues, embryonic and induced pluripotent stem cells may be more suitable for studying human development and tissue formation under diverse experimental conditions, and represent an excellent base for understanding human diseases and development of innovative therapeutic solutions. Among adult stem cells, mesenchymal stem cells are the most suitable for bone tissue engineering. They can be isolated from variety of mesenchymal tissues and can differentiate into osteoblasts when given appropriate mechanical support and osteoinductive signal. The near future of bone healing and regeneration is closely related to advances in tissue engineering. The optimization of protocols of bone graft production using autologous mesenchymal stem cells loaded on appropriate scaffolds, exposed to osteogenic inducers and mechanical force in bioreactor, should be able to solve the current limitations in managing bone injuries

OVERUSE INJURIES OF THE HIP JOINT

Bolni sindromi u području kuka se općenito smatraju najučestalijim sindromima prenaprezanja u nekim sportskim aktivnostima, npr. u nogometu. Razmatrajući lokaciju i anatomske strukture zahvaćene prenaprezanjima u području kuka, lokacija i karakteristika boli može biti točno lokalizirana, a isto tako može se raditi o neodređenoj difuznoj boli u području preponske regije, male zdjelice i natkoljenice. Naziv sindrom se s pravom upotrebljava, jer zaista postoje mnogobrojni simptomi kao što mogu biti i mnogobrojni uzroci nastanka pojave boli u području kuka. Za razumijevanje sindroma prenaprezanja u području kuka treba se samo podsjetiti koliki mišići se hvataju i polaze iz područja kuka. To su: grupa abdominalnih mišića, mišići aduktori, mišići stražnje strane natkoljenice, mišići vanjski rotatori kuka, m. ilopsoas, m. rectus femoris i drugi (sartorius, piramidalis, kremaster). U ovom preglednom radu iznijeti ćemo najnovije spoznaje najvažnijih i najčešćih sindroma prenaprezanja u području kukagroin strain; osteitis pubis; iliopsoas tendinitis and bursitis; tendinitis of the rectus femoris muscle; hip external rotator syndrome; gluteus medius syndrome; snapping hip; hamstring syndrom