Trohleoplastika: Kirurške indikacije i operacijska tehnika u liječenju rekurentne patelarne dislokacije pri uznapredovaloj patelofemoralnoj displaziji

Trochleoplasty is a surgical procedure which was initially reserved for the refractory cases where previous surgery has failed, but has become more popular in the past years because of a better knowledge of the knee anatomy and biomechanics and a greater availability of surgical instruments. The technical difficulty of the sulcus-deepening trochleoplasty lies in the fact that surgeons aim to reshape a usually extremely dysplastic articular surface of the trochlea without damaging it. If patients are carefully selected and the surgical rationale is carefully followed, recent bibliography presents very encouraging results of the application of trochleoplasty with other procedures in patients with severe trochlear dysplasia and recurrent patellar dislocation, in whom benign neglect of dysplasia would lead to unfavourable results. The surgical steps and technical pearls of the procedure are described in this review.Trohleoplastika je kirurški zahvat koji se koristi u liječenju rekurentnih dislokacija patele kod displazija patelofemoralnog zgloba. U početku se trohleoplastika primjenjivala samo kod pacijenata kod kojih ostale metode nisu polučile uspjeh. Kako saznanja o anatomiji i biomehanici napreduju, kao i tehnološka dostignuća u konstruiranju kirurških instrumenata, tako raste i popularnost takve vrste kirurškog zahvata raste. Radi se o zahtjevnom kirurškom zahvatu kod kojeg je potrebno preoblikovati displastično promijenjenu trohleu femura, a da se pritom značajno ne ošteti zglobna hrskavica. Noviji rezultati u pacijenata s visokim stupnjem displazije trohlee femura i rekurentnim dislokacijama patele, govore u prilog trohleoplastike u usporedbi s ostalim kirurškim postupcima. Ovaj rad u detalje opisuje kiruršku tehniku trohleoplastike

Concomitant ipsilateral subcapital and intertrochanteric fractures of the femur: a case report

Abstract Introduction We report the case of an unusual combination of concomitant subcapital and intertrochanteric fractures of the hip in a patient after a motorcycle accident. To the best of our knowledge, there is no previous report in the literature of these conditions as a result of high energy trauma or of the treatment used. Case presentation A 36-year-old Caucasian man was admitted with this rare fracture combination, and was managed with closed fracture reduction and fixation with a dynamic hip screw combined with an anti-rotational cannulated screw. We found four similar cases on reviewing the literature from 1989 to 2009, but these were reports of older patients after low energy injury. Conclusion We found that segmental fracture of the femoral neck region is an extremely rare and uncategorized hip injury that can occur not only in older people but also in young non-osteoporotic patients, and should be considered for inclusion in femoral fracture classification systems.</p

The “fish-vertebra” sign

The “fish-vertebra” sign appears as biconcave lumbar vertebrae with bone softening in lateral and posterior–anterior radiographs of the spine as an exaggeration of the normal concavity of the superior and inferior surfaces of one or more vertebral bodies. This is due to ischaemia of the central growth plate of the spine, and is typically seen in sickle cell disease

Impact of an antibiotic restriction policy on the antibiotic resistance patterns of Gram-negative microorganisms in an Intensive Care Unit in Greece

The purpose of this study was to investigate the influence of an antibiotic policy programme based on restriction of the empirical use of fluoroquinolones and ceftazidime on the susceptibilities of Gram-negative microorganisms in a general Intensive Care Unit (ICU). The epidemiology of infections caused by the predominant ICU pathogens, i.e. Acinetobacter baumannii, Pseudomonas aeruginosa and Klebsiella pneumoniae, and their resistance patterns as well as antibiotic consumption were recorded for a 6-month period. An antibiotic restriction policy including ceftazidime and quinolones was applied. After an 18-month period of protocol application, the same parameters were recorded for another 6-month period. Consumption of restricted and overall antibiotics was reduced by 92.5% and 55.4%, respectively. Susceptibilities to ciprofloxacin of the three predominant infection-causing Gram-negative bacilli were significantly increased. Ceftazidime showed an increase in susceptibility only for P. aeruginosa. Similar rates of infectious episodes were recorded in the two periods and no differences were observed either in overall mortality or in ICU ecology as expressed by the type of microorganisms implicated in colonisation and/or infection. The reported data suggest that an antibiotic restriction policy can significantly reduce antimicrobial consumption and antimicrobial resistance rates, although the latter effect can be also influenced by the prevalent resistance mechanisms and the prevalence of imported resistance. (C) 2007 Elsevier B.V and the International Society of Chemotherapy. All rights reserved

Are the tubular grafts in the femoral tunnel in an anatomical or isometric position in the reconstruction of medial patellofemoral ligament?

The purpose of this study was to evaluate the biomechanical results from the in vitro reconstruction of medial patellofemoral ligament (MPFL) using a navigation-assisted technique on a cadaveric model and its effects on patellar stability and kinematics. The authors investigated the hypothesis that patellar kinematics after reconstruction with a tubular graft are not optimal when compared with the original fan-shaped MPFL. METHODS: In six fresh-frozen cadaveric knees, lateral loads (25 N) were applied on the patella at 0°, 30°, 60° and 90° of knee flexion in three different MPFL states: intact, cut and reconstructed. The arrangement allowed positional measurements of patellar motion to be tracked in six degrees of freedom. Medial to lateral patellar translation and patellar tilt were recorded. The kinematics after a technique of MPFL reconstruction, performed with a gracilis tendon in a blind femoral tunnel guided by navigation, were compared against kinematics recorded in the MPFL intact state. A temporary fixation of adequate tension to engage the lateral patellar facet in extension was applied to the MPFL and, after graft cycling, the final fixation was done at 70° knee flexion with an interference screw. RESULTS: There was a comparable medial to lateral patellar translation and tilting of the patella in the MPFL-intact and the MPFL-reconstructed state. Static patellar translation in the MPFL-reconstructed state, with and without the application of load, was comparable to patellar translation in the MPFL-intact state. The dynamic patellofemoral shift kinematics recorded an under-constraint in early flexion and over-constraint in late flexion, while an opposite effect was recorded in patellar tilt. However, these differences were not statistically significant. CONCLUSION: The study confirmed the major role of the MPFL in case of medial loading between 0° and 60°, by focusing on the importance of kinematically identifying the proper femoral point for fixation. While the study demonstrates the importance of kinematic determination of the proper femoral point of fixation, as the anatomical insertion remains difficult to identify. Even in dissected cadavers, the authors recorded a slightly anterior placement than native MPFL. After reconstruction, patellar stability in terms of lateral translation and tilt was similar to the intact MPFL, but patellar kinematics were not optimal with the use of a smaller and tubular graft than the native wider and fan-shaped MPFL

Distal Locking of Tibial Nails: A New Device to Reduce Radiation Exposure

The indications for intramedullary nailing have expanded to include most tibial shaft fractures. Nail design has improved since their first introduction, but distal locking remains a difficult part of the procedure, resulting in radiation exposure to the patient and the surgeon and increased operation time. To address these issues, we describe an alternative surgical technique using a newly designed distal targeting device that consists of a proximally mounted aiming arm, and we report the preliminary data from its use in all tibial shaft fractures amenable to surgery for a 2–year period. Sixty-three tibial shaft fractures were treated with this method. The mean duration of the distal locking was 6.5 minutes, and in all successful cases, radiation exposure for distal locking was two shots (one shot before targeting and another for the confirmation of proper screw insertion). Radiation exposure was on average 0.85 seconds (range, 0.4–1.2 seconds) and 1.4 mGy (range, 0.8–1.9 mGy). There were no major intraoperative complications related to the technique. The method has certain advantages and can reduce radiation exposure and operation time. Nonetheless, familiarity with the instrumentation is a prerequisite for accurate distal locking