Wrist and hand sports injuries and lesions

Cilj: Prikazati iskustva u operacijskom liječenju sportskih ozljeda i oštećenja ručnog zgloba i šake u posljednjih 10 godina. Ispitanici i metode: U ovo istraživanje uključeno je 70 pacijenata kod kojih je učinjeno 70 operacija zbog sportske ozljede ili oštećenja ručnog zgloba i šake u periodu od 1. 3. 2010. do 31. 3. 2020. u Klinici za ortopediju i traumatologiju Lovran. Rezultati: Od 70 pacijenata uključenih u ovo istraživanje, njih 14 (20 %) je ženskog spola, a 56 (80 %) muškog spola. Raspon dobi pacijenata je od 10 do 50 godina. Prosječna dob pacijenata iznosi 23,7 ± 8,5 godina. Kod 35 (50 %) pacijenata bila je zahvaćena lijeva strana, a kod preostalih 35 (50 %) pacijenata desna strana. Kod 34 (49 %) pacijenata sportskom ozljedom ili oštećenjem bila je zahvaćena šaka, dok je kod 36 (51 %) pacijenata sportskom ozljedom ili oštećenjem bio zahvaćen ručni zglob. Od operacijski liječenih sportskih ozljeda u području šake (28) najzastupljeniji su operacijski zahvati osteosinteze prijeloma metakarpalnih kostiju (20) i falangi prstiju (8). Za razliku od operacijski liječenih sportskih ozljeda u području šake, učestalije je operacijsko liječenje sportskih oštećenja negoli ozljeda u području ručnog zgloba (P < 0,001). Zaključci: Ovo je prvo istraživanje u našoj populaciji kojim su dobiveni podaci o vrstama sportskih ozljeda i oštećenja ručnog zgloba i šake liječenih operacijski u posljednjih 10 godina. Gotovo 10 % operacija u području ručnog zgloba i šake su operacije sportskih ozljeda i oštećenja. Iako su prijelomi najčešći uzrok operacijskog liječenja sportskih ozljeda ručnog zgloba i šake, ozljede i oštećenja mekih tkiva ručnog zgloba i šake također su učestali uzrok operacijskog liječenja.Aim: To present experience in the surgical treatment of wrist and hand sports injuries in the last 10 years. Patients and Methods: The study included 70 patients in which, due to hand and wrist sports injuries and lesions, 70 surgeries were performed in the period from March 1st 2010 to March 31st 2020 at University Hospital for Orthopedics and Traumatology Lovran. Results: Of the 70 patients included in this study, 14 (20%) were women and 56 (80%) were men. The age range of the patients was from 10 – 50 years, and the average age was 23,7±8,5 years. The left side was affected in 35 (50%) patients, and the right side in 35 (50%) patients. The hand was affected in 34 (49%) patients with sports injury. The wrist was affected in 36 (51%) patients with sports injury. Of the surgically treated hand sports injuries (28), the most frequent surgical procedures were treatment of metacarpal (20) and phalangeal (8) fractures. Unlike surgically treated hand sports injuries, surgical treatment of wrist sports lesions is frequently than treatment of wrist sports injuries (P<0,001). Conclusions: This is the first study in our population which collected data about surgically treated wrist and hand sports injuries and lesions in the last 10 years. Nearly 10% of all wrist and hand surgeries are surgeries of sports injuries and lesions. Although fractures are the most common cause of surgical treatment for sports wrist and hand injuries, wrist and hand soft tissue injuries and lesions are also a common cause of surgery

Tibial Stress Fracture Simulate Osteomyelitic Foci in the Course of Chronic Recurrent Multifocal Osteomyelitis

Chronic recurrent multifocal osteomyelitis (CRMO) is an extremely rare and most severe form of chronic nonbacterial osteomyelitis of unknown etiology. Here we present the first case of a six-year-old girl in which was observed that the stress fracture mimic osteomyelitic foci in the course of CRMO

Hemiarthroplasty is an Effective Surgical Method to Manage Unstable Trochanteric Fractures in Elderly People

Trochanteric femoral fractures are a major problem in the elderly because of higher bone fragility due to osteoporosis. Numerous chronic illnesses, which usually affect the elderly, aggravate and complicate their surgical treatment. Trochanteric femoral fractures results in high morbidity and mortality in elderly patients. The aim of our study is to evaluate the effectiveness of hemiarthroplasty in the treatment of unstable trochanteric femoral fractures in elderly patients. Between 2000 and 2005, 50 patients with unstable trochanteric femoral fractures (41 women) aged 75 to 92 years (mean 86 years) underwent cemented hemiarthroplasty. The surgical procedure was performed within first 48 hours after the fracture (out of which 14 in the first 12 hours, 27 in the first 24 hours and 9 in the first 48 hours), with minimal blood loss. Hemiarthroplasty was indicated in patients where stability was important to allow early mobilization. In forty patients (80%) early ambulation with full weight bearing was achieved during the short period of hospitalization (9–14 days). Given that the affected population is predominantly the elderly, who are less mobile and demanding and thus put less strain on the endoprosthesis, we believe that this kind of treatment is the treatment of choice for unstable trochanteric femoral fractures in these patients. This assumption is corroborated by the fact that we did not have any endoprosthesis luxation, apparent acetabular protrusion or instability during the mean follow up period of 15 months (range 12–18 months)

Hemiarthroplasty is an Effective Surgical Method to Manage Unstable Trochanteric Fractures in Elderly People

Trochanteric femoral fractures are a major problem in the elderly because of higher bone fragility due to osteoporosis. Numerous chronic illnesses, which usually affect the elderly, aggravate and complicate their surgical treatment. Trochanteric femoral fractures results in high morbidity and mortality in elderly patients. The aim of our study is to evaluate the effectiveness of hemiarthroplasty in the treatment of unstable trochanteric femoral fractures in elderly patients. Between 2000 and 2005, 50 patients with unstable trochanteric femoral fractures (41 women) aged 75 to 92 years (mean 86 years) underwent cemented hemiarthroplasty. The surgical procedure was performed within first 48 hours after the fracture (out of which 14 in the first 12 hours, 27 in the first 24 hours and 9 in the first 48 hours), with minimal blood loss. Hemiarthroplasty was indicated in patients where stability was important to allow early mobilization. In forty patients (80%) early ambulation with full weight bearing was achieved during the short period of hospitalization (9–14 days). Given that the affected population is predominantly the elderly, who are less mobile and demanding and thus put less strain on the endoprosthesis, we believe that this kind of treatment is the treatment of choice for unstable trochanteric femoral fractures in these patients. This assumption is corroborated by the fact that we did not have any endoprosthesis luxation, apparent acetabular protrusion or instability during the mean follow up period of 15 months (range 12–18 months)

Shoulder pain

Bolno rame je jedno od najčešćih stanja s kojim se susreću liječnici u ortopediji i čini oko 20% patologije koštano-mišićnog sustava. Rameni je zglob zahvaljujući svojim biomehaničkim osobinama najpokretljiviji zglob u ljudskom tijelu, no ujedno i relativno nestabilan zglob, što ga čini posebno osjetljivim na ozljede. Uzroci bolnog ramena mogu biti različiti: upala i lezija tetiva rotatorne manžete, bolesti akromioklavikularnog zgloba, adhesivni kapsulitis, nestabilnosti ramena te artroza glenohumoralnog zgloba. Kliničkom slikom dominira bolnost uz koju je često prisutna smanjena gibljivost ramenog zgloba. S obzirom na važnu ulogu ramena u svakodnevnim aktivnostima iznimno je važno na vrijeme prepoznati uzrok bolnog ramena te započeti s adekvatnim liječenjem.Shoulder pain is one of the most common causes why people come to visit orthopaedic surgeons. It makes approximately 20% of musculoskeletal pathology. The shoulder`s biomechanical characteristics make it the most mobile joint but also one of the most unstable. The resulting ‘freedom of movement’ of the joint predisposes it to a variety of conditions. The causes of shoulder pain are: rotator cuff disorders, acromioclavicular joint disease, “frozen shoulder” and glenohumeral arthrosis. Shoulder problems tend to present mainly as pain, but it is not uncommon to have associated stiffness and restriction of movement. Due to the pivotal role the shoulder has in daily activities, it is essential that a good diagnosis of the principal shoulder pathology is made and a prompt recovery is started

Shoulder pain

Bolno rame je jedno od najčešćih stanja s kojim se susreću liječnici u ortopediji i čini oko 20% patologije koštano-mišićnog sustava. Rameni je zglob zahvaljujući svojim biomehaničkim osobinama najpokretljiviji zglob u ljudskom tijelu, no ujedno i relativno nestabilan zglob, što ga čini posebno osjetljivim na ozljede. Uzroci bolnog ramena mogu biti različiti: upala i lezija tetiva rotatorne manžete, bolesti akromioklavikularnog zgloba, adhesivni kapsulitis, nestabilnosti ramena te artroza glenohumoralnog zgloba. Kliničkom slikom dominira bolnost uz koju je često prisutna smanjena gibljivost ramenog zgloba. S obzirom na važnu ulogu ramena u svakodnevnim aktivnostima iznimno je važno na vrijeme prepoznati uzrok bolnog ramena te započeti s adekvatnim liječenjem.Shoulder pain is one of the most common causes why people come to visit orthopaedic surgeons. It makes approximately 20% of musculoskeletal pathology. The shoulder`s biomechanical characteristics make it the most mobile joint but also one of the most unstable. The resulting ‘freedom of movement’ of the joint predisposes it to a variety of conditions. The causes of shoulder pain are: rotator cuff disorders, acromioclavicular joint disease, “frozen shoulder” and glenohumeral arthrosis. Shoulder problems tend to present mainly as pain, but it is not uncommon to have associated stiffness and restriction of movement. Due to the pivotal role the shoulder has in daily activities, it is essential that a good diagnosis of the principal shoulder pathology is made and a prompt recovery is started

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

Open Total Talar Dislocation with Extrusion (Missing Talus)

Open total dislocation of a talus with extrusion (missing talus) is an extremely rare injury. We present a case of a 63-year-old male who sustained an open total lateral dislocation of the right talus with extrusion and without a concomitant fracture after a fall from a small height. Tibiocalcaneonavicular arthrodesis was performed. Arthrodesis failed, and due to painfull and unstable ankle, rearthrodesis was performed two years later, successefully. Because of rarity of this kind of injury, hers importance for foot function, previously described various treatment options and absence of guidelines, herewith we propose, according to our experience and review of literature, the algoritham for the treatment of this rare injury