Kvaliteta života u bolesnica s osteoporozom s prijelomom kuka i u onih bez prijeloma

The aim of this study was to analyse the quality of life in osteoporotic patients with hip fracture and those without fractures. The study included postmenopausal women, 35 with hip fracture and 33 without fractures. The control group included 44 age–matched healthy women. Osteoporosis Quality of Life Questionnaire was used to assess the health–related quality of life (HRQL). Patients with hip fracture had significantly lower scores in symptoms, physical function and leisure (P<0.05), than patients without fractures. Both groups of patients had significantly lower scores than controls in all domains except Leisure. Analysing several health and social factors that could influence HRQL, we found that bone mass in spine and femoral neck significantly correlated with HRQL. Since patients with osteoporosis usually have no symptoms before fracture, early diagnosis and the treatment of the disease are of key importance to the quality of life in these patients.Osteoporoza je bolest visoke prevalencije i poznata je kao “tiha epidemija” jer ne uzrokuje značajnije simptome sve do pojave prijeloma kostiju. Budući da osteoporotski prijelomi, osobito prijelom kuka, imaju ozbiljne zdravstvene i socijalne posljedice, kvaliteta života bolesnika nakon prijeloma postala je predmetom mnogih istraživanja o osteoporozi. U ovome ispitivanju analizirana je razlika u kvaliteti života između bolesnika s osteoporotskim prijelomom kuka i bolesnika s osteoporozom ali bez prijeloma. Sudjelovalo je 35 žena s prijelomom kuka i 33 žene s utvrđenom osteoporozom ali bez prijeloma. Sve ispitanice bile su u postmenopauzi i svima je učinjena denzitometrija skeleta. Za procjenu kvalitete života rabljen je upitnik Osteoporosis Quality of Life Questionnaire, koji se sastoji od 30 pitanja podijeljenih u pet kategorija: Simptomi, Emotivne funkcije, Fizičke funkcije, Aktivnosti dnevnog života i Socijalne aktivnosti i dokolica. Ispitanice s prijelomom kuka imale su značajno lošije vrijednosti nego žene bez prijeloma u kategorijama: Simptomi, Fizičke funkcije i Socijalne aktivnosti i dokolica. Obje grupe bolesnica imale su značajno niže vrijednosti pokazatelja kvalitete života u odnosu na kontrolnu skupinu žena bez koštanih bolesti. Analizom zdravstvenih i socijalnih parametara utvrđeno je da mineralna gustoća (osteoporoza) kralježnice i kuka imaju statistički značajan utjecaj na kvalitetu života. Zaključujemo da su rana dijagnoza i liječenje osteoporoze prije pojave prijeloma važni za izbjegavanje zdravstvenih i socijalnih teškoća i pada kvalitete života u bolesnika s osteoporozom

Osteosynthesis of pertrochanteric fractures in the elderly by the Ender\u27s method

Pertrohantemi prijelomi najčešće pogađaju osobe u starijoj životnoj dobi. Uzrok je većinom pad kod kuće kao posljedica mišićne diskoordinacije, uznapredovale osteoporoze, ateroskleroze i drugih kroničnih bolesti. Operacijsko liječenje ovih prijeloma posve je opravdano pa se u literaturi predlaže niz kirurških metoda stabilizacije. U ovom su radu prikazane indikacije, kontraindikacije i komplikacije za primjenu Enderovih čavala, te standardna tablica za procjenu postoperacijskih rezultata. Prema našem iskustvu, liječenje pertrohantemih prijeloma u starijih osoba primjenom Enderove metode ima prednost zbog jednostavnosti i kratkotrajnosti zahvata, minimalne traume i gubitka krvi, vrlo rijetke pojave infekcije te zadovoljavajuće fiksacije ulomaka. Navedene prednosti mogu imati presudni značaj u oporavku bolesnika starije životne dobi zbog narušenog općeg zdravstvenog stanja popraćenog brojnim kroničnim bolestima koje ne dopuštaju izlaganje organizma većem intraoperacijskom stresu.Pertrochanteric fractures usually happen to elderly people. They are mostly caused by a fall at home as a consequence of muscular discoordination, advanced osteoporosis, atherosclerosis or other chronic disease. Operative treatmant of these fractures is absolutley justified, so that several surgical stabilization mhetods can be found in literature. In this paper indications, contradictions and complications of the use of Ender’s nails are presented as well as the standard table for the assessment of postoperative results. Our experience shows that the treatmant of pertrochanteric fractures in the elderly by the Ender’s method has advantages due to its simplicity and short procedure, minimal trauma and blood loss, very rare infections and satisfactory fragment fixation. These advantages can be of decisive value for rehabilitation of elderly patients, who due to frequent chronic diseases, should not be exposed to a major intraoperative stress

RESULTS OF TREATMENT OF TIBIAL FRACTURES IN CHILDREN

Prijelomi dijafize obiju kosti potkoljenice najčešći su prijelomi donjih ekstremiteta i čine oko 15% svih prijeloma dugih kostiju u djece. To su većinom nestabilni prijelomi, teški za repoziciju i retenciju ulomaka, a postupak njihova liječenja nije posve usuglašen. U radu se analiziraju kasni rezultati liječenja 234-ero djece s prijelomima dijafize kostiju potkoljenice, ovisno o načinu liječenja (operacijska i konzervativna metoda). Otvoreni prijelom imala su 23 bolesnika, što čini 9,8% od ukupnog broja. U 194 bolesnika primijenili smo konzervativne metode, dok smo u njih 40 primijenili neke od operacijskih metoda liječenja. Najčešća korištena operacijska metoda bila je zatvorena repozicija ulomaka, na ekstenzijskom stolu i perkutana elastična stabilna intramedularna osteosinteza titanskim žicama. Za procjenu uspješnosti liječenja mjerene su zaostale kutne deformacije i razlike dužine zdrave i liječene noge. Sekundarni pomak ulomaka nakon započetoga konzervativnog liječenja, imala su 32 djeteta, što čini 15,2% od ukupnog broja konzervativno liječenih. Ukupno je 80-ero djece imalo zaostalu kutnu deformaciju liječene noge, njih 68 (35,0%) liječeno je konzervativno, a 12-ero (30,0%) operacijski. Bez razlike u dužini bolesne i zdrave noge bilo je 131 (67,5%) konzervativno liječeno dijete i 29-ero (72,5%) operacijski liječene djece. Ove razlike nisu statistički značajne. Rezultati liječenja ovih prijeloma u naše djece i autora sa sličnim serijama potvrđuju da nema statistički značajne razlike kasnih učinaka ovisno o načinu liječenja.Diaphyseal fractures of both lower leg bones are the most common fractures of lower extremities, and account for about 15% of all fractures of long bones in children. These fractures are usully unstabilae, difficult to reposition, and retention of the fragments, and the process of their treatment is not fully compliant. The paper analyzes the late results of treating 234 children with tibial fractures, depending on the method of treatment (surgical and conservative method). Twenty-three children had open fractures (9.8%). Nonsurgical method was used in the treatment of 194 children, and surgical in 40 children. The most frequent surgical method was closed reposition of the fragments, and percutaneous elastic stable intramedullary nailing with titanium wires. The success of the treatment was measured: residual angular deformities and difference in length beetwen treated and healthy leg. Secondary displacement of fragments after primary conservative treatment was found in 32 children. Angular deformities of the treated tibia was seen in 80 children, 68 (35.0%) treated conservatively and 12 (30.0%) surgically. In 131 (67.5%) conservatively treated and 29 (72.5%) surgically treated children there were no differences in the length of sick and healthy leg. Results of treatment in our children confirmed that there were no statistically significant differences in late effects depending on treatment methods

RESULTS OF TREATMENT OF DISPLACED SUPRACONDYLAR FRACTURES IN CHILDREN

Prijelomi humerusa u suprakondilarnom području najučestaliji su prijelomi lakta u dječjoj dobi. To su većinom nestabilani prijelomi, teški za repoziciju i retenciju ulomaka, a postupak njihova liječenja nije posve usuglašen. U radu se analiziraju kasni rezultati liječenja 48-ero djece s prijelomima humerusa u suprakondilarnom dijelu s pomakom ulomaka. Repozicijom zatvorenim načinom, fiksacijom s dvije ukriženo postavljene Kirschnerove žice i nadlaktičnom imobilizacijom liječeno je 40-ero, a osmero je djece liječeno samo nadlaktičnom imobilizacijom. Otvorena repozicija ulomaka bila je učinjena u troje djece. Za procjenu uspješnosti liječenja mjerene su kutne deformacije i usporedne razlike gibljivosti zdravog i liječenog lakta. Prema Flynnovu kriteriju 93,7% liječene djece ima vrlo dobre i odlične rezultate liječenja. Najučestalija je komplikacija varus angulacija (16,7%). Kasni rezultati liječenja u naše djece i rezultati autora sa sličnim serijama djece potvrđuju stav da je zatvorena repozicija i perkutana stabilizacija Kirschnerovim žicama metoda izbora u liječenju suprakondilarnih prijeloma humerusa s pomakom ulomaka.Supracondylar fractures of humerus are the most common fractures in children. The management of severely displaced, unstable fractures of the humerus in children continues to be controversial. We undertook a retrospective study of 48 children with displaced supracondylar fractures (8 were treated with plaster and 40 with cross percutaneous Kirschner wire pinning). Only three children were treated with open reduction and percutaneous cross-pin fixation. Clinical outcome was evaluated by loss of elbow motion and change of carrying angle. According to Flynn s criteria, results were good or excellent in 93.7% patients. The cubitus varus is the most frequent long-term complication (16.7%). Closed reduction with percutaneous pin fixation is believed to represent a safe, reliable, and efficient method of managing displaced supracondylar fractures

Intraoperative measurement of bone electrical potential: a piece in the puzzle of understanding fracture healing

INTRODUCTION: Bone electrical potentials change with the force applied. Also, fracture alters the bone electrical potential, so it becomes more electronegative. These potentials have an important role in fracture healing, bone growth and remodelling. Literature data on the influence of fracture operative treatment on bone electrical potentials, and possible consequences of this influence, are sparse. The objective of this study was to establish a method of intraoperative bone potential measurement, and to try to find a correlation between electrical potential and fracture type, osteosynthesis method and prognosis. ----- PATIENTS AND METHODS: 52 patients with a pertrochanteric fracture were included in the study. Bone electrical potentials were measured intraoperatively using a thin Kirschner wire introduced through bone cortex at the selected point and pointed to opposite cortex, not penetrating it. Kirschner wires were connected using clamps to multimeter (YF-78 Multimeter) device. Neutral electrode (inductive rubber) was placed behind ipsilateral gluteus. ----- RESULTS: Near the fracture site potentials of -199 up to -267 mV were recorded. Mean measured potential of bone plate after fixation was -240 mV. Bone potentials correlated with the subtype of fracture and early mobilisation of patients. ----- CONCLUSIONS: Bone potentials, caused by fracture, can be measured intraoperatively; the operative procedure appears to influence their generation. Measured potentials depend on the fracture type, and could be correlated with prognosis

Intraoperative measurement of bone electrical potential: a piece in the puzzle of understanding fracture healing

INTRODUCTION: Bone electrical potentials change with the force applied. Also, fracture alters the bone electrical potential, so it becomes more electronegative. These potentials have an important role in fracture healing, bone growth and remodelling. Literature data on the influence of fracture operative treatment on bone electrical potentials, and possible consequences of this influence, are sparse. The objective of this study was to establish a method of intraoperative bone potential measurement, and to try to find a correlation between electrical potential and fracture type, osteosynthesis method and prognosis. ----- PATIENTS AND METHODS: 52 patients with a pertrochanteric fracture were included in the study. Bone electrical potentials were measured intraoperatively using a thin Kirschner wire introduced through bone cortex at the selected point and pointed to opposite cortex, not penetrating it. Kirschner wires were connected using clamps to multimeter (YF-78 Multimeter) device. Neutral electrode (inductive rubber) was placed behind ipsilateral gluteus. ----- RESULTS: Near the fracture site potentials of -199 up to -267 mV were recorded. Mean measured potential of bone plate after fixation was -240 mV. Bone potentials correlated with the subtype of fracture and early mobilisation of patients. ----- CONCLUSIONS: Bone potentials, caused by fracture, can be measured intraoperatively; the operative procedure appears to influence their generation. Measured potentials depend on the fracture type, and could be correlated with prognosis

The periosteum Part 1: anatomy, histology and molecular biology

The periosteum is a thin layer of connective tissue that covers the outer surface of a bone in all places except at joints (which are protected by articular cartilage). As opposed to bone itself, it has nociceptive nerve endings, making it very sensitive to manipulation. It also provides nourishment in the form of blood supply to the bone. The periosteum is connected to the bone by strong collagenous fibres called Sharpey's fibres, which extend to the outer circumferential and interstitial lamellae of bone. The periosteum consists of an outer “fibrous layer” and inner “cambium layer”. The fibrous layer contains fibroblasts while the cambium layer contains progenitor cells which develop into osteoblasts that are responsible for increasing bone width. After a bone fracture the progenitor cells develop into osteoblasts and chondroblasts which are essential to the healing process. This review discusses the anatomy, histology and molecular biology of the periosteum in detail

Application of a novel bone osteotomy plate leads to reduction in heat-induced bone tissue necrosis in sheep

Previous studies have shown substantial effect thermal damage can have on new bone formation following osteotomy. In this study we evaluated the extent of thermal damage which occurs in four different methods of osteotomy and the effects it can have on bone healing. We further wanted to test whether a special osteotomy plate we constructed can lead to diminished heat generation during osteotomy and enhanced bone healing. The four methods evaluated included osteotomy performed by chisel, a newly constructed osteotomy plate, Gigly and oscillating saw. Twelve adult sheep underwent osteotomy performed on both tibiae. Bone fragments were stabilized using a fixation plate. Callus size was assessed using standard radiographs. Densitometry and histological evaluation were performed at 8 weeks following osteotomy. Temperature measurements were performed both in vivo during the operation, and ex vivo on explanted tibiae. The defects healed without complications and showed typical course of secondary fracture healing with callus ingrowth into the osteotomy gap. Radiographic examination of bone healing showed a tendency towards more callus formation in bones osteotomized using Gigly and oscillating saw, but this difference lacked significance. Use of Gigly and oscillating saw elicited much higher temperatures at the bone cortex surface, which subsequently lead to slightly impaired bone healing according to histological analysis. BMD was equal among all bones. In conclusion, the time required for complete healing of the defect differed depended greatly on the instruments used. The newly constructed osteotomy plate showed best results based on histological findings of capillary and osteoblast density

Rezultati liječenja prijeloma potkoljenice u djece [Results of treatment of tibial fractures in children]

Diaphyseal fractures of both lower leg bones are the most common fractures of lower extremities, and account for about 15% of all fractures of long bones in children. These fractures are usully unstabilae, difficult to reposition, and retention of the fragments, and the process of their treatment is not fully compliant. The paper analyzes the late results of treating 234 children with tibial fractures, depending on the method of treatment (surgical and conservative method). Twenty-three children had open fractures (9.8%). Nonsurgical method was used in the treatment of 194 children, and surgical in 40 children. The most frequent surgical method was closed reposition of the fragments, and percutaneous elastic stable intramedullary nailing with titanium wires. The success of the treatment was measured: residual angular deformities and difference in length between treated and healthy leg. Secondary displacement of fragments after primary conservative treatment was found in 32 children. Angular deformities of the treated tibia was seen in 80 children, 68 (35.0%) treated conservatively and 12 (30.0%) surgically. In 131 (67.5%) conservatively treated and 29 (72.5%) surgically treated children there were no differences in the length of sick and healthy leg. Results of treatment in our children confirmed that there were no statistically significant differences in late effects depending on treatment methods