Ishodi kirurškog liječenja dislociranih prijeloma oba stupca acetabuluma

Complex both-column acetabulum fractures are severe injuries, often with associated injuries and complications with uncertain clinical and functional outcome. Modern traumatological protocols point to early surgical treatment, with anatomical reduction and stable internal fixation of fragments as a prerequisite for achieving a good treatment outcome. This retrospective-prospective multicenter cohort study was conducted during the 2014-2020 period and included 24 cases that met the input parameters, using the Letournel and Judet classification, and application of a combined surgical approach, a modified Stoppa and Kocher-Langenbeck approach. The results of treatment with complications, associated injuries and functional outcome are described. Fractures were caused by high kinetic energy trauma, and the cause was traffic accident in 17/24 (70.84%), fall from a height in 5/24 (20.83%) and crash injuries in 2/24 (8.33%) cases. The sample included 18 (75.00%) male and 6 (25.00%) female, with 10/24 (41.67%) right sided and 14/24 (58.33%) left sided fractures. Their mean age was 45.06 (range, 24-62) years. The mean follow-up time was 2.8 (range, 1-5) years. Postoperative complications were detected in 14/24 (58.33%) cases, including wound infection in 4/24 (16.67%), deep vein thrombosis in 2/24 (8.33%), heterotopic ossification in 2/24 (8.33%), hip osteoarthrosis in 3/24 (12.50%), avascular necrosis of femoral head in 2/24 (8.33%), total hip arthroplasty procedures in 3/24 (12.50%), abdominal complications in 2/24 (8.33%), urologic complications in 2/24 (8.33%), iatrogenic nerve lesion in 3/24 (12.50%), and fatal pulmonary embolism in 2/24 (8.33%) cases; there was no loss of reduction or non-union acetabular fracture. Associated injuries that we recorded as major trauma were presented in 13/24 (54.17%) study patients. The final functional results according to the Harris Hip Score (HHS) were excellent in 7/22 (31.82%), good in 10/22 (45.45%), moderate in 4/22 (18.18%) patients, and poor in 1/22 (4.55%) patient. The mean HHS was 84 (range 34-98). Complications and results have led us to a conclusion that primary injuries significantly affect the clinical and functional results. A good diagnostic procedure, assessment of the general condition and application of the trauma scoring system, surgical treatment that includes early hip reduction, open reduction internal fixation and physical rehabilitation are necessary.Složeni prijelomi oba stupa acetabuluma teške su ozljede, često praćene pridruženim ozljedama i komplikacijama s neizvjesnim kliničkim i funkcionalnim ishodom. Suvremeni traumatološki protokoli ukazuju na rano kirurško liječenje s anatomskom repozicijom i stabilnom unutarnjom fiksacijom fragmenata kao preduvjet za postizanje dobrog ishoda liječenja. Ova retrospektivno-prospektivna multicentrična kohortna studija provedena je u razdoblju od 2014. do 2020. godine i uključila je 24 slučaja koji su zadovoljili ulazne parametre prema klasifikaciji Letournela i Judeta. Primijenjen je kombinirani kirurški pristup, tj. modificirani pristup Stoppe i Kocher-Langenbecka. Prikazuju se rezultati liječenja, komplikacije, pridružene ozljede i funkcionalni ishod. Prijelomi su nastali djelovanjem traume visoke kinetičke energije, a uzrok je bila prometna nesreća u 70,84% (17/24), pad s visine u 20,83% (5/24) i ozljede u sudaru u 8,33% (2/24) slučaja. Uzorak je obuhvatio 18 (75,00%) muškaraca i 6 (25,00%) žena s 41,67% (10/24) desnostranih i 58,33% (14/24) lijevostranih prijeloma. Srednja dob ispitanika bila je 45,06 (raspon 24-62) godina. Srednje vrijeme praćenja bilo je 2,8 (raspon 1-5) godina. Poslijeoperacijske komplikacije zabilježene su kod 58,33% (14/24) ispitanika, uključujući infekciju rane u 16,67% (4/24), duboku vensku trombozu u 8,33% (2/24), heterotopičnu osifikaciju u 8,33% (2/24), osteoartrozu kuka u 12,50% (3/24), avaskularnu nekrozu glave femura u 8,33% (2/24), totalnu artroplastiku kuka u 12,50% (3/24), abdominalne komplikacije u 8,33% (2/24), urološke komplikacije u 8,33% (2/24) ), jatrogenu leziju živaca u 8,33% (3/24), smrtonosnu plućnu emboliju u 8,33% (2/24), dok nismo imali gubitak redukcije i nesrastanje prijeloma. Pridružene ozljede zabilježene su kod 54,17% (13/24) ispitanika. Konačni funkcionalni rezultati prema Harris Hip Score (HHS) bili su odlični u 31,82% (7/22), dobri u 45,45% (10/22), umjereni u 18,18% (4/22) te loši u 4,55% (1/22) ispitanika. Srednja vrijednost HHS bila je 84 (raspon 34-98) bodova. Komplikacije i rezultati upućuju na zaključak da težina primarne ozljede značajno utječe na klinički i funkcionalni rezultat. Potreban je dobar dijagnostički postupak, procjena općeg stanja i primjena bodovnog sustava traume, kirurško liječenje koje podrazumijeva pravodobnu repoziciju kuka, otvorenu redukciju sa stabilnom unutarnjom fiksacijom prijeloma te fizikalnu rehabilitaciju

Osteomyelitis and septic arthritis in children and adolescents

Uzročnici, epidemiologija, dijagnostika pa i liječenje septičkog artritisa i osteomijelitisa u djece su se posljednjih godina promijenili. Najčešći uzročnik ostaju bakterije i to i dalje Staphyloccocus aureus dok je Haemophilus influenzae nakon uvođenja obaveznog cjepiva gotovo nestao. Standardno liječenje je i dalje empirijska antibiotska terapija u kombinaciji s kirurškim zahvatima. Nove sheme antibiotskog liječenja predviđaju samo nekoliko dana parenteralne primjene nakon čega slijedi peroralno liječenje. Kirurški zahvati iako u opadanju i dalje imaju važno mjestu u liječenju i to ponajviše dekompresijske procedure. Danas je smrtnost samo oko 1%, međutim čak i uz adekvatno liječenje, mogu završiti destrukcijom zgloba i ploče rasta, skraćenjem i angularnim deformacijama ekstremiteta i značajnim invaliditetom.Causative pathogens, epidemiology, diagnosis, and treatment of pediatric septic arthritis and osteomyelitis have changed remarkably over the past decade. Bacteria remain the most common pathogens, especially Staphylococcus aureus, while Haemophilus influenzae virtually perished after the introduction of obligatory vaccination. Empiric antibiotic therapy in combination with surgery remains the standard treatment. The trend of short-term course of parenteral antibiotic therapy followed by oral administration is observed in recent literature. Surgeries are still conducted, mostly decompression procedures. The mortality is around 1%, but even if adequate treatment is conducted, infectious diseases of locomotor system may lead to the destruction of the joint and growth plate, shortage and angular deformity of the extremity and substantial disability

EPIDURALNA ADHEZIOLIZA U LIJEČENJU KRONIČNE KRALJEŽNIČKE BOLI KOD SINDROMA NEUSPJELE OPERACIJE KRALJEŽNICE I KOD LUMBALNE RADIKULARNE BOLI: JEDNOGODIŠNJE ISKUSTVO U OPĆOJ BOLNICI PULA

Aim. The aim was to evaluate the effi cacy and feasibility of percutaneous adhesiolysis to reduce pain, improve daily functions and reduce drug use in patients with chronic pain. Chronic radicular pain can be caused by scar tissue, compression, infl ammation, or swelling disks. Adhesiolysis by placement of a wire-bound catheter into the ventrolateral aspect of the epidural space at the site of the exiting nerve root enables precise application of steroids, hyaluronidase, local anesthetics and saline for to achieve pain relief. Methods: Standard percutaneous epidural adhesiolysis was performed in 54 patients divided into two groups: pain from failed back surgery syndrome (FBSS) versus chronic radicular pain without previous spine surgery. Visual analog scale (VAS) score, change in pharmacotherapy used, subjective satisfaction and evaluation of the lysis procedure were observed in pretreatment, and then in the 4th and 12th week of the intervention. Results: VAS scores for pain were signifi cantly reduced in both groups in the 4th and 12th week. A statistically signifi cant decrease was expressed in the radiculopathy group (VAS0=7.5±0.87/VAS12th=4.6±1.05) versus FBSS group (VAS0=7.6±0.85/VAS12th=5.0±1.58) (p50% was achieved in 27% of FBSS patients and 25% of patients with chronic radicular pain without surgery experience. Conclusion: Considering the small sample size, our results in short-term pain relief suggested that epidurolysis could be an effective method in the treatment of patients with chronic radicular pain as in patients with FBSS.Cilj: Cilj ove randomizirane studije bila je procjena izvodivosti i učinkovitosti adheziolize u liječenju kronične kralježničke boli, njezin utjecaj na poboljšanje kvalitete života, odnosno njezin učinak na kroničnu analgetsku terapiju. Epiduralna adhezioliza omogućava postavljanje posebno dizajniranih katetera u ventrolateralni aspekt epiduralnog prostora, tj. u neposrednoj blizini izlazaćeg živčanog korijena i preciznu primjenu steroida, hijaluronidaze i lokalnih anestetika u cilju smanjenja fenomena boli. Metoda: U studiju su usključena 54 bolesnika podijeljena u dvije skupine: bolesnici s kroničnom boli nakon neuspjele kralježničke operacije (FBSS) naspram bolesnika s kroničnom radikularnom boli bez prethodnog kirurškog iskustva. Nakon 4. odnosno 12. tjedna od postupka praćene su promjene u vizualno analognoj ljestvici boli (VAS), u farmakoterapijiskom unosu, u stupnju subjektivnog životnog zadovoljstva bolesnika, kao i procjena ukupnog učinka adheziolize. Rezultati: Prosječna razina boli (VAS) bila je značajno smanjena u obje skupine i u 4. i u 12. tjednu. Statistički značajno smanjenje izraženo je u skupini radikulopatije (VAS 0 = 7,5 0,87 / VAS 12th = 4,6 1,05) u odnosu na FBSS skupinu (VAS 0 = 7,6 0,85 / VAS 12th = 5,0 1,58) (p 50 % smanjenja inicijalne boli iskazala se u 27 % pacijenata s FBSS i u 25 % bolesnika s kroničnom radikularnom boli. Zaključak: S obzirom na naš mali uzorak, ostvareni rezultati u kratkoročnom ublažavanju boli ukazuju da epiduralna adhezioliza može biti učinkovita metoda u liječenju bolesnika s kroničnom radikularnom boli kao što je to u bolesnika s FBSS

Incarcerated Diaphragmatic Hernia – Differential Diagnoses

The incarceration of diaphragmatic hernia is very rare. We present a case of a four-year old girl who developed the incarceration of left-sided diaphragmatic hernia, who, until then, was completely asymptomatic. This incarceration of the hernia represented a surgical emergency presenting as obstructive ileus and a severe respiratory distress which developed from what appeared to be full health. During a brief pre-operative examination a number of differential diagnoses were suggested. Along with the laboratory blood analysis (complete blood count and acid-base balance) a plain thoracic and abdominal radiography was done (babygram). After that, through an inserted nasal-gastric tube, barium meal of the upper gastrointestinal tract was done, showing abdominal organs in the left half of the thorax and a signifi cant shift of the mediastinum to the right. With an urgent upper medial laparotomy we accessed the abdominal cavity and made the correct diagnosis. An opening was shown in the rear part of the left hemi-diaphragm with thickened and edematous edges, approx. 6 cm in diameter with incarcerated content. The incarcerated abdominal organs (stomach, transversal colon, small intestine and spleen) gradually moved into the abdominal cavity. The opening was closed with nonresorptive sutures (TiCron) size 2-0 with a previous control and ventilated expansion of the well-developed left lung. In postoperative course the acid-base balance quickly recovered, as well as the general state of the patient and radiography showed a good expansion and lucency of the lung parenchyma and a return of the mediastinum into the middle part of the thorax

EPIDURALNA ADHEZIOLIZA U LIJEČENJU KRONIČNE KRALJEŽNIČKE BOLI KOD SINDROMA NEUSPJELE OPERACIJE KRALJEŽNICE I KOD LUMBALNE RADIKULARNE BOLI: JEDNOGODIŠNJE ISKUSTVO U OPĆOJ BOLNICI PULA

Aim. The aim was to evaluate the effi cacy and feasibility of percutaneous adhesiolysis to reduce pain, improve daily functions and reduce drug use in patients with chronic pain. Chronic radicular pain can be caused by scar tissue, compression, infl ammation, or swelling disks. Adhesiolysis by placement of a wire-bound catheter into the ventrolateral aspect of the epidural space at the site of the exiting nerve root enables precise application of steroids, hyaluronidase, local anesthetics and saline for to achieve pain relief. Methods: Standard percutaneous epidural adhesiolysis was performed in 54 patients divided into two groups: pain from failed back surgery syndrome (FBSS) versus chronic radicular pain without previous spine surgery. Visual analog scale (VAS) score, change in pharmacotherapy used, subjective satisfaction and evaluation of the lysis procedure were observed in pretreatment, and then in the 4th and 12th week of the intervention. Results: VAS scores for pain were signifi cantly reduced in both groups in the 4th and 12th week. A statistically signifi cant decrease was expressed in the radiculopathy group (VAS0=7.5±0.87/VAS12th=4.6±1.05) versus FBSS group (VAS0=7.6±0.85/VAS12th=5.0±1.58) (p50% was achieved in 27% of FBSS patients and 25% of patients with chronic radicular pain without surgery experience. Conclusion: Considering the small sample size, our results in short-term pain relief suggested that epidurolysis could be an effective method in the treatment of patients with chronic radicular pain as in patients with FBSS.Cilj: Cilj ove randomizirane studije bila je procjena izvodivosti i učinkovitosti adheziolize u liječenju kronične kralježničke boli, njezin utjecaj na poboljšanje kvalitete života, odnosno njezin učinak na kroničnu analgetsku terapiju. Epiduralna adhezioliza omogućava postavljanje posebno dizajniranih katetera u ventrolateralni aspekt epiduralnog prostora, tj. u neposrednoj blizini izlazaćeg živčanog korijena i preciznu primjenu steroida, hijaluronidaze i lokalnih anestetika u cilju smanjenja fenomena boli. Metoda: U studiju su usključena 54 bolesnika podijeljena u dvije skupine: bolesnici s kroničnom boli nakon neuspjele kralježničke operacije (FBSS) naspram bolesnika s kroničnom radikularnom boli bez prethodnog kirurškog iskustva. Nakon 4. odnosno 12. tjedna od postupka praćene su promjene u vizualno analognoj ljestvici boli (VAS), u farmakoterapijiskom unosu, u stupnju subjektivnog životnog zadovoljstva bolesnika, kao i procjena ukupnog učinka adheziolize. Rezultati: Prosječna razina boli (VAS) bila je značajno smanjena u obje skupine i u 4. i u 12. tjednu. Statistički značajno smanjenje izraženo je u skupini radikulopatije (VAS 0 = 7,5 0,87 / VAS 12th = 4,6 1,05) u odnosu na FBSS skupinu (VAS 0 = 7,6 0,85 / VAS 12th = 5,0 1,58) (p 50 % smanjenja inicijalne boli iskazala se u 27 % pacijenata s FBSS i u 25 % bolesnika s kroničnom radikularnom boli. Zaključak: S obzirom na naš mali uzorak, ostvareni rezultati u kratkoročnom ublažavanju boli ukazuju da epiduralna adhezioliza može biti učinkovita metoda u liječenju bolesnika s kroničnom radikularnom boli kao što je to u bolesnika s FBSS

Dislocated Left Knee Injury and Popliteal Arteries of the Left Knee

The bone and joint injuries include fractures of the extremities, sprains and strains of joints. The complications that threaten the vitality of the limb or permanently damage its functions have been reported in a small percentage of injuries of extremities. The biggest threat to the limb are threatening injuries blood supply, primarily direct injury artery or sometimes vein. Closed injuries can cause ischemia by interruption of arterial blood supply, as is the case at the back sprains knee, hip and supracondylar humerus fractures with displacement. In our case, the rear dislocation of the knee led to the injury of artery with ischemia on the periphery of the left leg , and the only timely diagnosis and surgery, the patient was saved foot

Dislocated Left Knee Injury and Popliteal Arteries of the Left Knee

The bone and joint injuries include fractures of the extremities, sprains and strains of joints. The complications that threaten the vitality of the limb or permanently damage its functions have been reported in a small percentage of injuries of extremities. The biggest threat to the limb are threatening injuries blood supply, primarily direct injury artery or sometimes vein. Closed injuries can cause ischemia by interruption of arterial blood supply, as is the case at the back sprains knee, hip and supracondylar humerus fractures with displacement. In our case, the rear dislocation of the knee led to the injury of artery with ischemia on the periphery of the left leg , and the only timely diagnosis and surgery, the patient was saved foot

Dislocated Left Knee Injury and Popliteal Arteries of the Left Knee

The bone and joint injuries include fractures of the extremities, sprains and strains of joints. The complications that threaten the vitality of the limb or permanently damage its functions have been reported in a small percentage of injuries of extremities. The biggest threat to the limb are threatening injuries blood supply, primarily direct injury artery or sometimes vein. Closed injuries can cause ischemia by interruption of arterial blood supply, as is the case at the back sprains knee, hip and supracondylar humerus fractures with displacement. In our case, the rear dislocation of the knee led to the injury of artery with ischemia on the periphery of the left leg , and the only timely diagnosis and surgery, the patient was saved foot

Prikaz slučaja 17-godišnje djevojke s okluzijom lijeve poplitealne i desne radijalne arterije

This is a case of a 17-year old girl with right radial and left popliteal arterial occlusion. This was diagnosed with clinical examination, arterial colour doppler and pletismography. For further evaluation this girl was refered to KBC Zagreb, Pediatric clinic and Clinic for heart and coronary deseases where she was diagnosed with antiphospholipidal syndrome. Her laboratory parameters tested positive for lupus anticoagulant. Digital subtraction angiography confirmed the colour dopler results