Komparativna analiza rezultata operativnog lečenja preloma dijafize butne kosti metodom zaključavajućeg intramedularnog klina i samodinamizirajućeg unutrašnjeg fiksatora po Mitkoviću

Introduction: The incidence of fracture of the femur bone ranges from 1.5 to 9.9: 100 000 persons during the year, and most commonly isolated injuries. Material and methods: The study was conducted on a sample of 100 subjects with 104 fractures, divided into two groups based on the treatment method. The average monitoring time is 12-23 months. In the first group, with selfdynamizable internal fixator (SIF) was used in 55 patients with 57 fractures. In the second group, in 45 subjects with 47 fractures treated with interlocking femoral nails. Both surgical methods are based on the concept of relative stability. For AO / ASIF classification (type A 39, tips B 51, type C 14), Winquist Hansen (type I 28, type II 39, type III 23, type IV 14) and Gustillo Anderson classification (Type I 7 and Type II 2). The analized complications are: infection, nonunion, deformity of the extremities (malposition of the axis, rotation and length), malunion et break and displacement of osteosynthetic material, deep vein thrombosis, pulmonary embolism, neurovascular injury, compartment syndrome, and amputation. Objective: Comparative analysis of the process of scaling, functional recovery and complications between these two methods of treatment of femoral shaft fracture. Discussion: Protocols and trauma scores provide guidelines for a diagnostic pathway for adequate orthopedic care, contributing to reducing morbidity, mortality and more successful treatment. In politraumatized special effects in improving treatment, it has been shown through guidelines based on two principles: early total care ETC and damage control orthopaedic DCO. Conclusion: Both methods equally enable the achievement of good results of treatment, which is displayed through the values of the analyzed parameters

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

Liječenje ozljeda medijalnog meniskusa parcijalnom meniscektomijom

Partial meniscectomy involves partial removal of the meniscus. This can vary from minor trimming of the damaged part of the meniscus to the removal of the rip from the meniscocapsular junction. Meniscus tears are the most common knee injury. They may occur in acute knee injuries in younger patients, or as part of a degenerative process in older individuals. The aim of the study was to demonstrate the method of choice for treatment of medial meniscus injuries that, in well selected cases, resulted in a small rate of complications and fast rehabilitation. The study analyzed the results of arthroscopic partial medial meniscectomy in 99 patients, in the period from 2005 to 2013, with follow up of 12-14 months. In our series of arthroscopically treated medial meniscus, tears were found in 29 patients with vertical complete bucket handle lesions, 14 with vertical incomplete lesions, 9 with longitudinal tears, 13 with oblique tears, 11 with complex, flap and degenerative lesions, 10 with radial lesions and 13 with horizontal lesions. The mean preoperative International Knee Documentation Committee score was 52.52%, then 81.81% at one month and 92.92% at six months of arthroscopic partial medial meniscectomy. Arthroscopic partial medial meniscectomy is a minimally invasive diagnostic and therapeutic procedure. This procedure is an acceptable and effective long-term treatment, particularly in patients without significant articular cartilage damage, and is associated with minimal morbidity.Parcijalna meniscektomija podrazumijeva djelomično uklanjanje meniskusa. Ovo može varirati od manje ekstirpacije oštećenog dijela meniskusa do uklanjanja rascjepa s meniskokapsularnog hvatišta. Ozljede meniskusa su najčešće ozljede koljena. One se mogu javiti kao akutne ozljede koljena kod mlađih bolesnika ili kao dio degenerativnog procesa u starijih osoba. Cilj studije bio je pokazati metodu izbora u liječenju ozljeda medijalnog meniskusa koja u dobro odabranim slučajevima dovodi do malog postotka komplikacija i brze rehabilitacije. U studiji su analizirani rezultati artroskopske parcijalne medijalne meniscektomije kod 99 bolesnika u razdoblju od 2005. do 2013. godine s praćenjem kroz 12-14 mjeseci. U našoj seriji bolesnika liječenih ovom metodom utvrđen je rascjep poput drške košarice (bucket handle) u 29, vertikalni nepotpuni rascjep u 14, uzdužni rascjep u 9, kosi rascjep u 13, degenerativna lezija u 11, radijalni rascjep u 10 i horizontalni rascjep u 13 bolesnika. Prosječni prijeoperacijski zbir IKDC (International Knee Documentation Committee) bio je 52,52%, jedan mjesec nakon parcijalne artroskopske medijalne meniscektomije IKDC je bio 81,81%, a šest mjeseci nakon parcijalne meniscektomije 92,92%. Artroskopska parcijalna medijalna meniscektomija je minimalno invazivan dijagnostički i terapijski zahvat. Ona je prihvatljiva i učinkovita kao liječenje, naročito kod bolesnika bez značajnog oštećenja zglobne hrskavice, a praćena je minimalnim pobolom

Usporedba anterogradne i retrogradne aplikacije humeralnog čavla

Application of humeral nail in the treatment of humeral shaft fractures is a relatively novel method of fracture fixation. Its application at Clinical Department of Traumatology, Sestre milosrdnice University Hospital Center began in 2001. The operative procedure should be performed using a minimally invasive technique without fracture opening in order to maintain optimal conditions for fracture healing including hematoma management. However, in everyday practice it is often impossible to obtain satisfactory fracture reduction using the closed procedure, so open reduction and additional fixation with wires or screws are mandatory. Over the last 14 years, fixation of fractures with the locking nail was performed in more than 400 patients. Cases of pseudarthrosis and pathological fractures were also managed successfully. There were more female patients. The mean time from injury to surgery was 2.4 days. Surgery was performed immediately upon admission to the emergency service whenever possible. This study comprised 234 patients with humeral shaft fractures treated with the humeral nail (antegrade insertion was applied in 103 and retrograde in 131 patients). The aim of the study was to stress out the complexity of appropriate operative treatment of humeral shaft fractures using intramedullary fixation, as well as the importance of proper reduction and stable fixation.Upotreba usidrenog humeralnog čavla u liječenju prijeloma i psudartroza nadlaktične kosti relativno je nova metoda fiksacije. U svijetu se počinje koristiti početkom 1990.-ih godina, a u Klinici za traumatologiju KBC-a Sestre milosrdnice primjenjuje se od 2001. godine. Operacija bi se u načelu trebala izvoditi minimalno invazivno bez otvaranja frakturnog predjela s ciljem očuvanja povoljnih lokalnih uvjeta za sanaciju prijeloma koje nam nudi frakturni hematom. Međutim, u praksi često nije moguće zadovoljavajuću repoziciju izvesti zatvoreno te je potrebno prijelom eksponirati i dodatno fiksirati serklažnim žicama ili vijcima. U posljednjih 13 godina fiksacija prijeloma s usidrenim čavlom učinjena je u preko 400 bolesnika. Uspješno su tretirane i pseudartroze i patološki prijelomi. Što se tiče spolne distribucije, prijelom je bio 2 puta više zastupljen u ženskoga spola. Srednje vrijeme od ozljede do operacije iznosilo je 2,4 dana. Ako su uvjeti i stanje bolesnika dozvoljavali, operacija se izvodila odmah nakon prijma u hitnoj službi. U ovoj studiji obrađeno je 234 bolesnika, od kojih je 110 bolesnika operirano retrogradnom aplikacijom, a 124 anterogradnom aplikacijom čavla. Cilj istraživanja bio je naglasiti složenost odgovarajućeg operativnog liječenja prijeloma dijafize humerusa koristeći intramedularnu fiksaciju, kao i važnost dobre repozicije i stabilne fiksacije ulomaka

The prediction of criminal recidivism in male juvenile delinquents

Rezultati dosadašnjh istraživanja su ukazali na jaku vezu između kriminalnog ponašanja maloletnih delinkvenata sa jedne strane i crta ličnosti i odnosa u porodici sa druge strane. Međutim, još uvek se malo zna o tome koliko su odnosi unutar porodice i karakteristike ličnosti povezani sa kriminalnim recidivizmom. Cilj istraživanja bio je da ispita ove odnose koristeći kraću verziju skale Velikih pet + dva (Neuroticizam, Ekstraverzija, Otvorenost za iskustvo, Savesnost, Prijatnost, Pozitivna valenca, Negativna valenca), Skalu kvaliteta porodičnih interakcija (zadovoljstvo porodicom, prihvatanje/odbacivanje od strane majke/oca) i zvanične podatke iz kriminalnih dosija. Istraživanje je sprovedeno na 61 institucionalizovanom delinkventu i 64 ne-delinkventa, uzrasta od 15 do 18 godina. Neuroticizam, Otvorenost za iskustvo, Savesnost, Negativna valenca, prihvatanje od strane oca i odbacivanje od strane majke su statistički značajni prediktori kriminalnog recidivizma maloletnih delinkvenata. Delinkventi su pokazali statistički značajno više skorove na Neuroticizmu, kao i niže na Savesnosti i prihvatanju od strane majke u odnosu na ne-delinkvente.Previous studies have demonstrated a strong association of criminal behavior of juvenile delinquents with delinquents' personality traits and family interactions. However, little is known about the extent to which family interactions and personality traits are associated with criminal recidivism. The present study aimed to examine these relationships, using the Velikih pet plus dva (Big Five Plus Two) - short version (assessing Neuroticism, Extraversion, Openness to experience, Conscientiousness, Aggressiveness, Positive Valence, Negative Valence), the Quality of Family Interaction Scale (Satisfaction with family, Mother and Father Acceptance/Rejection), and official data from criminal records. The study included 61 institutionalized delinquents and 64 non-delinquents, 15 to 18 years of age. Neuroticism, Openness to experience, Conscientiousness, Negative valence, acceptance by father and rejection by mother are statistically significant predictors of criminal recidivism in juvenile delinquents. Delinquents showed higher Neuroticism, lower Conscientiousness and acceptance by mother compared to non-delinquents

Spearheading into the Neolithic: last foragers and first farmers in the Dinaric Alps of Montenegro

This article presents a summary of new evidence for the Mesolithic in the Dinaric Alps of Montenegro. The region is one of the best areas in south-eastern Europe to study Early Holocene foragers and the nature of the transition to Neolithic lifeways at the end of the seventh and the beginning of the sixth millennium cal BC thanks to the existence of biodiverse landscapes and numerous karstic features. We argue that harpoons found at two different sites in this regional context represent a curated technology that has its roots in a local Mesolithic cultural tradition. The continued use of this standardized hunting tool kit in the Neolithic provides an important indication about the character of the Mesolithic–Neolithic transition. We also use this regional case study to address wider questions concerning the visibility and modes of Mesolithic occupation in south-eastern Europe as a whole

Liječenje periprotetskih prijeloma bedrene kosti nakon totalne proteze kuka kod Vankuverskog tipa B

Th e rate of periprosthetic femoral fractures following total hip replacement has been growing steadily in the last 20 years and ranges from 0.1% to 2.1%. These fractures are mostly related to older patients with the presence of chronic diseases and frequently poor bone quality. Th e treatment is surgically very complex and demanding, followed by a series of complications. Th e evaluation in this retrospective study included 23 patients who were medically treated from January 2004 to December 2015 with the mean follow-up of 14.5 (range, 9-25) months. Th ere were 17 patients with cement total hip arthroplasty (THA) and 6 with cementless THA. During treatment of fractures, different techniques were implemented including the use of wire cerclage, dynamic compression plates (DCP), a locking compression plate (LCP) system, and long revision stem. For the purpose of distinguishing fractures, we used the Vancouver classifi cation by Duncan and Masri. For clinical evaluation, we used the modifi ed Merle d’Aubigne score system and monitored complications during treatment. Th e aim is to show treatment results of the type B periprosthetic femoral fractures by using diff erent operative treatment techniques. According to the Vancouver classifi cation within type B, 10 (43.47%) patients had type B1 fractures, another 10 (43.47%) patients had type B2 fractures, and three (13.04%) patients had type B3 fractures. According to gender distribution, there were eight (34.8%) male and 15 (65.2%) female patients, mean age 59.5 (range, 47-86) years. Twelve (52.2%) and 11 (47.8%) patients had left- and right-sided fractures, respectively. Th e mean length of hospital stay was 16 (range, 9-26) days. According to the Merle d’Aubigne score system, 10 patients with type B1 fractures had the mean score of 11.5 points, which is poor result. Poor result was also recorded in patients with type B2 fractures, with the mean score of 10.6 points. Th e three patients with type B3 fractures had the mean score of 12 points, which is considered fair score. In conclusion, Vancouver classifi cation has been widely accepted and using the protocols makes decision making during treatment much easier. During treatment of this type of fracture, we used various implants, wire cerclage, DCP and LCP, as well as long stem revision. In certain cases, we applied surgical techniques, implants that are not recommended by the Vancouver protocol by which we treated periprosthetic femoral fractures; in these case, we recorded nonunion bone, malunion and breaking of implants, which resulted in poor treatment outcome.Incidencija periprotetskih prijeloma bedrene kosti kod totalne proteze kuka (TPK) je u stalnom porastu u posljednja dva desetljeća i kreće se u opsegu od 0,1%-2,1%. Ovi su prijelomi karakteristični za osobe starije životne dobi s prisutnim kroničnim bolestima, često slabijom kvalitetom kosti, a samo liječenje je kirurški složeno i zahtjevno te praćeno nizom komplikacija. Ova retrospektivna studija je obuhvatila 23 bolesnika liječenih u razdoblju od siječnja 2004. do prosinca 2015. godine. Srednje vrijeme praćenja je bilo 14,5 (od 9 do 25) mjeseci. Bilo je 17 bolesnika s cementnom i šest s bescementnom TPK. U rješavanju prijeloma rabili smo različite tehnike: uporabu žičanih serklaža, DC ploče, LCP sustava i dugog revizijskog stema. Za podjelu prijeloma služili smo se Vankuverskom klasifi kacijom po Duncanu i Masriju. Za kliničku evaluaciju rabili smo modifi cirani Merle d’Aubigneov sustav bodova i pratili komplikacije tijekom liječenja. Cilj je prikazati rezultate liječenja periprotetskih femoralnih prijeloma tipa B nakon uporabe različitih operativnih tehnika i implantata u rješavanju ovoga tipa prijeloma. Prema Vankuverskoj klasifi kaciji unutar tipa B zabilježena je podklasifi kacija na B1 s 10 (43,47%) bolesnika, B2 s 10 (43,47%) bolesnika i B3 s 3 (13,04%) bolesnika. Distribucija bolesnika prema spolu bila je: 8 (34,8%) muškog spola i 15 (65,2%) ženskog spola. Srednja životna dob ispitanika bila je 59,5 (47-86) godina. Od ukupnog broja ispitanika bilo ih je 12 (52,2%) s prijelomom na lijevoj i 11 (47,8%) na desnoj strani. Srednje vrijeme hospitalizacije je bilo 16 (9-26) dana. Primjenom Merle d’Aubigneova sustava bodova kod 10 bolesnika s prijelomom B1 dobivena je srednja ocjena od 11,5 bodova (loš rezultat). Kod 10 bolesnika s prijelomom B2 dobivena je srednja ocjena od 10.6 bodova (loš rezultat). Kod 3 ispitanika s prijelomom B3 dobivena je srednja ocjena od 12 bodova (dovoljan rezultat). Vankuverska klasifikacija i protokol liječenja za periprotetske femoralne prijelome kod TPK je opće prihvaćena i daje sigurne smjernice u donošenju odluke pri liječenju, odnosno korištenju implantata. U našem radu rabili smo različite implantate, žičane serklaže, DC ploču, LCP sustav i dugi revizijski stem u kiruškom liječenju ovoga tipa prijeloma. U određenom broju slučajeva primijenili smo kirurške tehnike odnosno implantate koje ne preporučuje Vankuverski protokol; u ovim slučajevima zabilježen je izostanak cijeljenja kosti, pomicanje i lomljenje implantata, što je rezultiralo nezadovoljavajućim ishodom liječenja

Surgical treatment of unstable pelvic ring fractures

Background/Aim. Pelvic ring fractures are complex injuries and are often associated with internal organs injuries. These injuries require rapid and accurate diagnosis and in some cases one or more surgical interventions. The aim of this retrospective study is to describe the indications and outcomes of surgical treatment of pelvic ring injuries with the emphasis on anatomical reconstruction and stable osteosynthesis as a prerequisite for early mobilization and more favorable functional outcomes. Methods. In the period from 2006 to 2012, fifty-five patients with pelvic ring injuries with or without acetabular fractures were analyzed. The average age of all patients was 36 years. Forty-one patients were treated with operational open reduction and internal fixation (ORIF) while nine of them were treated nonoperatively (bed rest, skeletal traction and external fixation). Results. All operated patients were treated within 3- 24 days with ORIF, stable osteosynthesis and early mobilization which resulted in avascular necrosis (AVN) of the femoral head in two cases. AVN of the femoral head was noted in five cases in combined and isolated pelvic ring injuries and acetabulum which were treated with skeletal traction. Neurological deficit was recorded in three patients treated with conservative methods while two patients underwent ORIF. Deep vein thrombosis (DVT) was noted in two patients and pulmonary thromboembolism appeared in one patient 23 days after surgical intervention. Two infections occurred around Steinman pins in the patients who had the definitive treatment performed with external fixator. In one patient treated with ORIF a superficial infection occurred and was treated with antibiotics. The functional results were evaluated based on Merle d'Aubigné score. The results of the radiography treatment were analyzed according to Slatis. Conclusion. Strict application of rational criteria and surgical technique with stable internal fixation with early mobilization provide significantly better outcomes of these injuries in relation to non surgical treatment or treatment with definitive external fixation

ETHIOLOGY AND MECHANISMS OF INJURIES OF KNEE ANTERIOR CRUCIATE LIGAMENT IN ATHLETES

The examined group was composed of 60 patients with injuries of Anterior Cruciate Ligament (ACL) treated at the Clinical Center of Montenegro from 2006- 2010. Among general population the frequency is 1:3000, and around 70% of ACL injuries occur as a consequence of sports activity. These traumas represent 15-30% of all sports injuries. Normal kinematics of a knee joint means intact ligament. The purpose of our work was to determine the risk factors of injury, regarding training and competing process, daily activity and their connection with the mechanism of injury. In our inquiry, recreational athletes represented 70% of patients.The most common mechanism of injury is a non-contact, deceleration, valgus angulation with an external rotation as a consequence of landing, sudden change of direction, running rhythm, or fall. The largest number of injuries occurs in training, recreation, tournaments, and everyday activities. In diagnostics we employed clinical tests, ECHO finding, NMR and arthroscopy. Sports activity during which our patients obtained most of their injuries is soccer. Traumas were frequently followed by damages to their joint structures (meniscus, cartilage). Injuries of ACL are multifactorial etiologies, but through external and internal factors, adequate communication, and sports culture of partakers (athletes, trainers and physicians) can be acted preventively on decreasing injury incidence and timely and adequate treatmen