THE RESULTS OF INTERNAL FIXATION OF PROXIMAL HUMERAL OSTEOPOROTIC FRACTURES WITH PHILOS LOCKING PLATE

Background: In the last fifty years since plate and screw osteosynthesis has been implemented in fracture treatment, osteosporotic bone fractures were observed as a special problem. Due to special histologic, anatomic, physical and biomehanic properties of osteoporotic changed bone the laws of biomechanics suggest that stable osteosynthesis for osteoporotic bone is necessary to increase the contact surface of metallic implants and bone and the stability of the screw-plate-bone compound. There are numerous surgical techniques and methods for treatment of osteoporotic proximal humeral fractures. Every surgical procedure has to establish anatomical reduction and stable fixation that will enable early mobilisation. Subjects and methods: The aim of this study was to present results of internal fixation of proximal humeral osteoporotic fractures with PHILOS locking plate. Between 2007 and 2012, a total of 67 patients older than 65 years with closed proximal humerus fractures underwent surgical treatment with PHILOS plate system (Synthes, Switzerland). 42 patients were operated with deltopectoral approach and 25 with deltoid split approach. After a mean follow up period of 14.68 (6-28) months functional and radiologic results were assessed. Results: We noted 9 postoperative complications related to surgical technique (1 intraarticular screw placement, 1 displacement in major tuberculum fragment, 1 displacement in major tuberculum fragment along with oblique placement of the plate, 2 cases of inadequate reduction, 1 case of humeral head avascular necrosis, varus humeral head fixation in 3 cases). None of the patients developed superficial or deep surgical infection. There was no nonunions. In the final evaluation, the Constant shoulder score was 91.75 (72-100). Conclusions: In this study PHILOS locking plate showed good applicability, respecting bone biologic properties because of negligible interference with blood supply of the humeral head. There was no requirement to shape the plate enabling stabilization at constant angles as clear benefit of this plate. All that enables early mobilisation, and no implant insufficiency resulting in satisfactory treatment results and high Constant shoulder scores

THE RESULTS OF INTERNAL FIXATION OF PROXIMAL HUMERAL OSTEOPOROTIC FRACTURES WITH PHILOS LOCKING PLATE

Background: In the last fifty years since plate and screw osteosynthesis has been implemented in fracture treatment, osteosporotic bone fractures were observed as a special problem. Due to special histologic, anatomic, physical and biomehanic properties of osteoporotic changed bone the laws of biomechanics suggest that stable osteosynthesis for osteoporotic bone is necessary to increase the contact surface of metallic implants and bone and the stability of the screw-plate-bone compound. There are numerous surgical techniques and methods for treatment of osteoporotic proximal humeral fractures. Every surgical procedure has to establish anatomical reduction and stable fixation that will enable early mobilisation. Subjects and methods: The aim of this study was to present results of internal fixation of proximal humeral osteoporotic fractures with PHILOS locking plate. Between 2007 and 2012, a total of 67 patients older than 65 years with closed proximal humerus fractures underwent surgical treatment with PHILOS plate system (Synthes, Switzerland). 42 patients were operated with deltopectoral approach and 25 with deltoid split approach. After a mean follow up period of 14.68 (6-28) months functional and radiologic results were assessed. Results: We noted 9 postoperative complications related to surgical technique (1 intraarticular screw placement, 1 displacement in major tuberculum fragment, 1 displacement in major tuberculum fragment along with oblique placement of the plate, 2 cases of inadequate reduction, 1 case of humeral head avascular necrosis, varus humeral head fixation in 3 cases). None of the patients developed superficial or deep surgical infection. There was no nonunions. In the final evaluation, the Constant shoulder score was 91.75 (72-100). Conclusions: In this study PHILOS locking plate showed good applicability, respecting bone biologic properties because of negligible interference with blood supply of the humeral head. There was no requirement to shape the plate enabling stabilization at constant angles as clear benefit of this plate. All that enables early mobilisation, and no implant insufficiency resulting in satisfactory treatment results and high Constant shoulder scores

Introduction of chronical wounds healing with Lucilia sericata larvae in Slovenia

Izhodišča Ker so kronične rane danes pogosto okužene z bakterijskimi sevi, odpornimi na antibiotike, je njihovo zdravljenje težavno. Namen raziskovalnega projekta je bil uvesti v Slovenijo novo metodo zdravljenja kroničnih ran z uporabo ličink muh Lucilia sericata. Metode Za zdravljenje kroničnih ran smo uporabili sterilne larve L. sericata, pridobljene v kontinuirani kulturi na Oddelku za biologijo Biotehniske fakultete UL. Na ta način smo zdravili 32 ran pri 30 bolnikih. Ličinke smo na rani pustili delovati dva do tri dnič nato smo jih odstranili in po potrebi ponovno namestili. Pred namestitvijo in po njej smo jemali mikrobiološke brise tkiva vrani in iz njih osamili ter identificirali bakterijske vrste. Med biokirurskim zdravljenjem smo spremljali potek zdravljenja, bolnikovo počutje, morebitne bolečine, pokretnost, samostojnost in psiholoski odziv ob terapiji. Rezultati Z biokirurskim zdravljenjem smo uspeli zaceliti in očistiti 24 ran od 32 (75%). V primeru kombinirane arterijsko-venske razjede smo uspeli popolnoma zaceliti eno rano in očistiti 8 ran, v primeru venske razjede na nogi in sestih diabetičnih razjed so se vse rane očistile. V primerih preležanin in pooperativnih kroničnih ran smo z biokirurgijo vse ranev celoti očistili. 16 bolnikov je med nosenjem ličink občutilo neprijeten občutek, pri dveh so se pojavile bolečine, ki so se po dodatku analgetikov pomirile. Med zdravljenjem si je pri hoji z berglami pomagalo 17 (57%) bolnikov. Ugotovili smo, da je 17 bolnikov (57%) čutilo strah in depresijo ter nelagoden občutek. Zaključki Metoda zdravljenja z ličinkami muhe L. sericata je bila uspešno uvedena v Slovenijo. Zaradi enostavnosti in uspešnosti bi jo bilo potrebno kot način zdravljenja uvesti tudi v vsakdanjo slovensko klinično prakso. Z biokirurgijo se kronične rane hitreje celijo, preprečimo nadaljnja vnetja in propadanje tkiva ter bolniku omogočimo normalno vključevanje v vsakdanje življenje.Background Due to infection of chronic wounds with antibiotic resistant bacterial strains, their healing can be very difficult. The main purpose of the presented research study was the introduction of a new method for chronic wounds healing, using Lucilia sericata fly larvae into Slovenia. Methods For chronic wound healing sterile larvae of L. sericata fly were prepared from a continuous fly culture, maintained at the Department of Biology, Biotechnical Faculty, University of Ljubljana. In this way 32 wounds of 30 patients were treated. Larvae were applied on the wounds for two to three days. Than they were washed off and replaced, if necessary. Microbiological smears were collected before and after the application of the larvae on the wounds. Microorganisms were then isolated and identified. During larval therapy healing improvement, patientćs general state, potential presence of pain, mobility, patientćs independence and psychological reaction to the therapy were monitored. Results Using biosurgical therapy 24 (75%) out of 32 wounds were cleaned and healed. In the case of combined arterio-venous leg ulcers onewound was completely healed and eight of them were cleaned of necrosis and infection. In the case of a venous leg ulcer, six diabetic ulcers, eight casesof chronic postoperative wounds and pressure ulcers, wounds were completely cleaned after the treatment. 16 patients reported unpleasant feeling during larval treatment and two patients felt pain which diminished after the treatment with analgesics. 17 (57%) patients had to use crutches during biosurgical treatment and the same number of patients felt uncomfortable, frightened and depressed during the application of larvae