14 research outputs found
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 ageāmatched healthy women. Osteoporosis Quality of Life Questionnaire was used to assess the healthārelated 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 ātiha epidemijaā jer ne uzrokuje znaÄajnije simptome sve do pojave prijeloma kostiju. BuduÄi 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 izmeÄu bolesnika s osteoporotskim prijelomom kuka i bolesnika s osteoporozom ali bez prijeloma. Sudjelovalo je 35 žena s prijelomom kuka i 33 žene s utvrÄenom osteoporozom ali bez prijeloma. Sve ispitanice bile su u postmenopauzi i svima je uÄinjena 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, FiziÄke funkcije, Aktivnosti dnevnog života i Socijalne aktivnosti i dokolica. Ispitanice s prijelomom kuka imale su znaÄajno loÅ”ije vrijednosti nego žene bez prijeloma u kategorijama: Simptomi, FiziÄke funkcije i Socijalne aktivnosti i dokolica. Obje grupe bolesnica imale su znaÄajno niže vrijednosti pokazatelja kvalitete života u odnosu na kontrolnu skupinu žena bez koÅ”tanih bolesti. Analizom zdravstvenih i socijalnih parametara utvrÄeno je da mineralna gustoÄa (osteoporoza) kralježnice i kuka imaju statistiÄki znaÄajan utjecaj na kvalitetu života. ZakljuÄujemo da su rana dijagnoza i lijeÄenje osteoporoze prije pojave prijeloma važni za izbjegavanje zdravstvenih i socijalnih teÅ”koÄa i pada kvalitete života u bolesnika s osteoporozom
Osteosynthesis of pertrochanteric fractures in the elderly by the Ender\u27s method
Pertrohantemi prijelomi najÄeÅ”Äe pogaÄaju osobe u starijoj životnoj dobi. Uzrok je veÄinom pad kod kuÄe kao posljedica miÅ”iÄne diskoordinacije, uznapredovale osteoporoze, ateroskleroze i drugih kroniÄnih bolesti. Operacijsko lijeÄenje ovih prijeloma posve je opravdano pa se u literaturi predlaže niz kirurÅ”kih metoda stabilizacije. U ovom su radu prikazane indikacije, kontraindikacije i komplikacije za primjenu Enderovih Äavala, te standardna tablica za procjenu postoperacijskih rezultata. Prema naÅ”em iskustvu, lijeÄenje 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 zadovoljavajuÄe fiksacije ulomaka. Navedene prednosti mogu imati presudni znaÄaj u oporavku bolesnika starije životne dobi zbog naruÅ”enog opÄeg zdravstvenog stanja popraÄenog brojnim kroniÄnim bolestima koje ne dopuÅ”taju izlaganje organizma veÄem 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 Enderās 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 Enderās 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 najÄeÅ”Äi su prijelomi donjih ekstremiteta i Äine oko 15% svih prijeloma dugih kostiju u djece. To su veÄinom nestabilni prijelomi, teÅ”ki za repoziciju i retenciju ulomaka, a postupak njihova lijeÄenja nije posve usuglaÅ”en. U radu se analiziraju kasni rezultati lijeÄenja 234-ero djece s prijelomima dijafize kostiju potkoljenice, ovisno o naÄinu lijeÄenja (operacijska i konzervativna metoda). Otvoreni prijelom imala su 23 bolesnika, Å”to Äini 9,8% od ukupnog broja. U 194 bolesnika primijenili smo konzervativne metode, dok smo u njih 40 primijenili neke od operacijskih metoda lijeÄenja. NajÄeÅ”Äa koriÅ”tena operacijska metoda bila je zatvorena repozicija ulomaka, na ekstenzijskom stolu i perkutana elastiÄna stabilna intramedularna osteosinteza titanskim žicama. Za procjenu uspjeÅ”nosti lijeÄenja mjerene su zaostale kutne deformacije i razlike dužine zdrave i lijeÄene noge. Sekundarni pomak ulomaka nakon zapoÄetoga konzervativnog lijeÄenja, imala su 32 djeteta, Å”to Äini 15,2% od ukupnog broja konzervativno lijeÄenih. Ukupno je 80-ero djece imalo zaostalu kutnu deformaciju lijeÄene noge, njih 68 (35,0%) lijeÄeno je konzervativno, a 12-ero (30,0%) operacijski. Bez razlike u dužini bolesne i zdrave noge bilo je 131 (67,5%) konzervativno lijeÄeno dijete i 29-ero (72,5%) operacijski lijeÄene djece. Ove razlike nisu statistiÄki znaÄajne. Rezultati lijeÄenja ovih prijeloma u naÅ”e djece i autora sa sliÄnim serijama potvrÄuju da nema statistiÄki znaÄajne razlike kasnih uÄinaka ovisno o naÄinu lijeÄenja.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 podruÄju najuÄestaliji su prijelomi lakta u djeÄjoj dobi. To su veÄinom nestabilani prijelomi, teÅ”ki za repoziciju i retenciju ulomaka, a postupak njihova lijeÄenja nije posve usuglaÅ”en. U radu se analiziraju kasni rezultati lijeÄenja 48-ero djece s prijelomima humerusa u suprakondilarnom dijelu s pomakom ulomaka. Repozicijom zatvorenim naÄinom, fiksacijom s dvije ukriženo postavljene Kirschnerove žice i nadlaktiÄnom imobilizacijom lijeÄeno je 40-ero, a osmero je djece lijeÄeno samo nadlaktiÄnom imobilizacijom. Otvorena repozicija ulomaka bila je uÄinjena u troje djece. Za procjenu uspjeÅ”nosti lijeÄenja mjerene su kutne deformacije i usporedne razlike gibljivosti zdravog i lijeÄenog lakta. Prema Flynnovu kriteriju 93,7% lijeÄene djece ima vrlo dobre i odliÄne rezultate lijeÄenja. NajuÄestalija je komplikacija varus angulacija (16,7%). Kasni rezultati lijeÄenja u naÅ”e djece i rezultati autora sa sliÄnim serijama djece potvrÄuju stav da je zatvorena repozicija i perkutana stabilizacija Kirschnerovim žicama metoda izbora u lijeÄenju 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 āfibrous layerā and inner ācambium layerā. 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 lijeÄenja 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