Distal tibial pilon fractures (AO/OTA type B, and C) treated with the external skeletal and minimal internal fixation method

Background/Aim. Distal tibial pilon fractures include extra-articular fractures of the tibial metaphysis and the more severe intra-articular tibial pilon fractures. There is no universal method for treating distal tibial pilon fractures. These fractures are treated by means of open reduction, internal fixation (ORIF) and external skeletal fixation. The high rate of soft-tissue complications associated with primary ORIF of pilon fractures led to the use of external skeletal fixation, with limited internal fixation as an alternative technique for definitive management. The aim of this study was to estimate efficacy of distal tibial pilon fratures treatment using the external skeletal and minimal internal fixation method. Methods. We presented a series of 31 operated patients with tibial pilon fractures. The patients were operated on using the method of external skeletal fixation with a minimal internal fixation. According to the AO/OTA classification, 17 patients had type B fracture and 14 patients type C fractures. The rigid external skeletal fixation was transformed into a dynamic external skeletal fixation 6 weeks post-surgery. Results. This retrospective study involved 31 patients with tibial pilon fractures, average age 41.81 (from 21 to 60) years. The average follow-up was 21.86 (from 12 to 48) months. The percentage of union was 90.32%, nonunion 3.22% and malunion 6.45%. The mean to fracture union was 14 (range 12-20) weeks. There were 4 (12.19%) infections around the pins of the external skeletal fixator and one (3.22%) deep infections. The ankle joint arthrosis as a late complication appeared in 4 (12.90%) patients. All arthroses appeared in patients who had type C fractures. The final functional results based on the AOFAS score were excellent in 51.61%, good in 32.25%, average in 12.90% and bad in 3.22% of the patients. Conclusion. External skeletal fixation and minimal internal fixation of distal tibial pilon fractures is a good method for treating all types of inta-articular pilon fractures. In fractures types B and C dynamic external skeletal fixation allows early mobility in the ankle joint. [Projekat Ministarstva nauke Republike Srbije, br. III41017

Study on preparation and properties of novel functionalized polyester copolymers based on siloxanes

Novel functionalized macroporous copolymers were synthesized by reaction of the pendant epoxy groups of poly(glycidyl methacrylate)-co-poly(ethylene glycol dimethacrylate)s with 1,3-bis(3-aminopropyl)tetramethyldisiloxane (TMDS) and α,ω-diamino propyl poly(dimethylsiloxane) (PDMS). It was found that the optimal conditions for the synthesis of functionalized copolymers were: reaction temperature of 80 o C, reaction time of 10 h and a mixture of N-methyl-2-pyrrolidone/toluene (1/3 v/v) as the solvent. The effects of the type of siloxanes and concentration of glycidyl methacrylate on the structure and properties of functionalized copolymers were investigated by solid-state 13C and 29Si NMR spectroscopy, FTIR spectroscopy, differential scanning calorimetry (DSC), thermogravimetric analysis (TGA), and scanning electron microscopy (SEM). The structure of functionalized copolymers was confirmed by solid-state NMR and FTIR spectroscopy. The DSC results showed that the glass transition temperatures of copolymers were in the range from 63 to 65 o C and they slightly depend on the copolymer composition exclusively. The thermal stability was better for copolymers functionalized with TMDS in comparison with PDMS based copolymers. Thermal degradation of the synthesized copolymers starts between 276 and 290 o C. The TG curves of all copolymers display two stages of degradation at 308-368 o C (stage 1) and 395-430 o C (stage 2) which are associated with the ester and siloxane bonds. The results indicated that the thermal stability depends on the type of siloxanes and copolymer composition. The surface and crosssection morphology was investigated by SEM and the porous copolymer beads were confirmed by SEM analysis. SEM studies with energy dispersive X-ray mapping revealed that siloxanes migrate to the surface of samples due to their low surface energy. By varying the structure of siloxanes and copolymer composition, functionalized copolymers can be designed and synthesized with diverse physical properties for different purposes

Novel siloxane based polyurethane nanocomposites

A series of novel thermoplastic polyurethanes (TPUs) nanocomposites based on α,ω–dihydroxy ethoxy propyl poly(dimethylsiloxane) (EOPDMS), 1,4-butanediol (BD) and 4,4'-diphenylmethane diisocyanate (MDI) was synthesized by in situ two-step polyaddition reaction in solution using modified clay (Cloisite 30B). The clay percentage in the nanocomposites was 1, 3, 5, 8 and 10 wt% in relation to the polymers. The aim of this study was to improve some properties of TPUs by the addition of clay nanoparticles. The prepared nanocomposites were characterized using FTIR, AFM and DSC analyses. The influence of nanoparticles dispersion on the morphology and thermal properties of TPUs was investigated

Eritropoetin u procjeni ishoda liječenja kod bolesnika s politraumom

Polytrauma is a term describing patients with injuries involving multiple body regions that compromises function of the body and/or organ involved. The aim of the study was to evaluate the potential role of erythropoietin in predicting poorer outcome in trauma patients. This prospective study included 86 patients admitted to the Emergency Center of Serbia due to polytrauma assigned according to Injury Severity Score (ISS). The patients were further evaluated using the Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores and erythropoietin levels. There was a significant difference among erythropoietin levels at admission, after 48 and 72 hours, and on day 7 of hospital stay, with significantly higher levels in patients with ISS values 49-75. Based on the results, ROC curves were used to identify cut-off levels to predict ISS score with critical clinical course. It was concluded that erythropoietin could be a good marker of injury severity. Further research has to be performed to determine the cut-off values of erythropoietin that are significant for injury severity.Politrauma je termin koji opisuje bolesnike s povredama koje uključuju više dijelova tijela i koje ugrožavaju funkciju ­tijela i/ili organa. Cilj studije je bio procijeniti potencijalnu ulogu eritropoetina u predviđanju lošeg ishoda kod bolesnika s poli­traumom. Ova prospektivna studija obuhvatila je 86 bolesnika koji su primljeni u Urgentni centar Srbije zbog politraume dijagnosticirane prema rezultatu težine povreda (Injury Severity Score, ISS). Bolesnici su dalje procijenjeni pomoću rezultata Akutnog fiziološkog bodovnog sustava i bodovnog sustava kronične procjene zdravlja II. te procjene insuficijencije organa i razine eritropoetina. Postojala je značajna razlika između razine eritropoetina kod prijma, poslije 48 i 72 sata te sedmog dana boravka u bolnici, sa znatno višim razinama kod bolesnika s vrijednostima ISS 49-75. Na osnovi rezultata krivulje ROC su primijenjene za identifikaciju graničnih vrijednosti kako bi se predvidio rezultat ISS s kritičnim kliničkim tijekom. Zaključeno je da eritropoetin može biti dobar pokazatelj ozbiljnosti povreda. Potrebno je daljnje istraživanje za određivanje graničnih vrijednosti eritropoetina koje su značajne za ozbiljnost povreda

Application of Landsat-derived NDVI in monitoring and assessment of vegetation cover changes in Central Serbia

This paper evaluates the application of the Normalised Difference Vegetation Index (NDVI) in the monitoring and assessment of temporal vegetation cover changes (from 2006 to 2014) in three municipalities of Central Serbia: Topola, Jagodina and Kuršumlija. Additionally, special focus is placed on the analysis of the forest areas and the possible use of NDVI in the forest management sector. Results of the NDVI applied through Idrisi software identify all vegetation cover types and their typical values for presented case studies and observed periods. Obtained results for Serbian case studies indicate two major observations outlined for the investigated period. It was noticed that vegetation cover is experiencing a certain decrease, and that certain discrepancies exists between the NDVI and official forest area statistics for certain municipalities. The study outlines the positive outcomes of the applied remote sensing techniques, especially for southern Serbian municipalities where illegal logging activities are pronounced. Hence, this method proved very promising for countries performing national forest inventories, such as Serbia, providing local forest managers with several essential up-to-date information about vegetation cover changes on an annual basis. © 2019 Carpathian Journal of Earth and Environmental Sciences

Surgical treatment of disloced fracture of the scapula column and glenoid: A 22-year follow-up

Introduction. Most scapular fractures are caused by highimpact blunt injuries, often as the result of motor vehicle accidents, fall from height, etc. In 80% to 90% of cases, scapula fractures are associated with multiple injuries (clavicle fracture, rib fractures, humeral fracture, pulmonary injury, brachial plexus injury). Case report. We presented scapular fracture in a 27-years-old male who had sustained a workrelated injury when a ground soil brick machine pressed him. Fracture line was identified on radiotherapy and computed tomography scan from the distal scapular angle enclosing scapular neck. The whole lateral part of the scapula was dislocated laterally from the scapular body. Scapular fracture was treated operatively. The posterior approach was used for reposition, while for fixation after reposition we used two Blunt clamps. We presented functional outcome 22 years after the injury and the surgical treatment. The patient can perform all physical activities, still works, and there is no need to remove the ostheosynthetic material as it causes no discomfort nor problems. The strength of the shoulder muscles is estimated as physician as the grade 5. Conclusion. Displaced intraarticular fractures of the scapula should be treated operatively, with open reduction and internal fixation

Femoroacetabular impingement after the femoral neck fracture healed in a nonanatomical position

Introduction. Femoroacetabular impingement is the result of the pathological conditions in the osseous acetabulum and/or the proximal femur. One of its causes is a non-anatomically healed femoral neck fracture. Case report. A male, aged 51, with a subcapital left femoral neck fracture was treated conservatively. The fracture healed 9 months later and although the patient was walking on crutches he suffered from pain in the left groin. The X-ray images showed the valgus and the retroposition of the left femoral head. The patient was operated on and intraoperatively the thickness and a bone prominence in the anterosuperior femoral neck area in the line of the previous fracture were found, which was pressing and spreading beneath the acetabular labrum, thus squeezing the acetabular cartilage. The labrum lesion which was found was the result of the mechanical pressure of the existing femoral neck deformity during the hip movements. Irretrievably damaged part of the labrum was resected and the anterosuperior femoral headneck osteochondroplasty was done. One year after the surgery, the patient had no pain, he walked without limping, the impingement test was negative, the radiological parameters were adjusted and there were no signs of the avascular necrosis of the femoral head. Conclusion. The femoral neck fracture should be treated adequately with the full anatomical position and the proper internal fixation. If the deformity occurs as the result of a treatment, it should be removed as soon as possible to prevent the osteoarthritis of the hip

First experiences with the Fitmore® hip stem: Early results of the 16-month monitoring

Background/Aim. Fitmore® hip stem belongs to the group of short stem prostheses with the metaphysar stabilization, with its shape and form that protects the bone mass in the greater trochanter region and the distal part of the femur. The aim of this paper was to present the early postoperative results in patients with implanted Fitmore® hip stem and point out some of the advantages. Methods. A series of 10 patients with implanted Fitmore® hip stem, was included in this study. The average age of the patients was 54.5 (48–65) years. There were 5 women and 5 men. The total monitoring time was 16 months. To rate the condition of the hip joint we used The Western Ontario and Mc Master Universities Arthritis Index (WOMAC) score. We also monitored the degree of hip pain, hip flexion, heterotopic ossification and indentation in the stem of the prosthesis. Results. After 12 months of monitoring 9 (90%) of the patients had no pain in the thigh region, and only 1 (10%) experienced mild pain. The hip flexion rose from the average 89° to postoperative 114°. WOMAC score rose as well, from 49 to 94 average points. Indentation in the stem was registered 3 months after the operation in 2 (20%) of the patients – in one of the patients the indentation was 3 mm and in the other patient 5 mm. After the 16-month monitoring, the results were excellent. The monitoring period was short though it should be continued and the results should be presented after 5 and then after 10 years. Conclusion. Early results of the implantation Fitmore stem showed good bone ingrowth with excellent functional result

Surgical dislocation of the hip in patients with femoroacetabular impingement: Surgical techniques and our experience

Background/Aim. Arthrosis of the hip is the most common cause of a hip joint disorders. The aim of this study was to present our experience in the application of a safe surgical dislocation of the hip in patients with minor morphological changes in the hip joint, which, through the mechanism of femoroacetabular impingement, cause damage to the acetabular labrum and adjacent cartilage as an early sign of the hip arthrosis. Methods. We have operated 51 patients with different morphological bone changes in the hip area and resultant soft tissue damage of the acetabular labrum and its adjacent cartilage. Surgical technique that we applied in this group of patients, was adapted to our needs and capabilities and it was minimaly modified compared to the original procedure. Results. The surgical technique presented in this paper, proved to be a good method of treatment of bone and soft tissue pathomorphological changes of the hip in patients with femoroacetabular impingement. We had no cases with avascular necrosis of the femoral head, and two patients had nonunion of the greater trochanter, 9 patients developed paraarticular ossification, without subjective symptoms, while 3 patients suffered from postoperative pain in the groin during more energetic physical activities. Conclusion. Utilization of our partly modified surgical technique of controlled and safe dislocation of the hip can solve all the bone and soft tissue problems in patients with femoroacetibular impingement to stop already developed osteoarthritis of the hip or to prevent mild form of it

Open wedge osteotomy and callus distraction by means of the external fixator in distal femur and proximal tibia in knee arthrosis with valgus and varus deformity

Various methods can be applied for treatment of knee deformity. One of them is open wedge osteotomy and callus distraction by means of the external fixator. This paper presents the results of treatment of 16 patients with knee arthrosis associated with varus and valgus deformities (10 varus and 6 valgus deformities). Open wedge osteotomy of the varus deformity was performed in the proximal tibia, and in case of the valgus deformity in the distal part of the femur. The patients who were operated on had a knee varus larger than 10 degrees and a knee valgus larger than 12 degrees. Prior to open wedge osteotomy and application of the external fixator, knee arthroscopy was performed (meniscectomy, cartilage drilling and shaving, debridement, the extraction of loose bodies). After one-year follow-up, the final outcome of the treatment was positive in all patients. The treatment alleviated the pain in these patients. The method is minimally invasive and relatively easily applied. Mitkovic's external fixator type M20-CD-V allows for continuous callus distraction with simultaneous correction of the varus or valgus knee deformity