The comparative analysis of the results achieved in the trochanteric fracture treatment

This doctoral thesis deals with the current problem of osteoarticular system and trochanteric fracture treatment of people who are 60 or more years old. The fracture is treated by extramedular implants, DHS-YU, selfdynamizing fixator-Mitkovic and DHS-Richards. The thesis contains both experimental and clinical part of study. In the experimental part of the thesis, you can find a research carried out on biomechanic characteristics of the implants and dinamization at the axis neck under cyclic loading. Wooden femur models with virtual trochanteric fracture are used (under fracture corner of 45º) and they are fixed with a corresponding implant. At the Faculty of Engineering in Nis, a research was carried out with a specific instrument used for cyclic examination. It has been used for the implant testing since 2007. Wooden femur models are used for testing the implant resistence on the axial force. As an equipment part, we used a “twitcher” (Veb Thuringer Raunsteim). During the procedure we used power of 1000N. One hundred and fifty patients who were 60 or more years old, took part in the clinical prospective study.They all had a trochanteric fracture and were all treated with the dynamic extramedular implant, DHS-YU, self-dynamizing fixator-Mitkovic and DHS-Richards, at the orthopedic ward in Cuprija and at the orthopedic clinical ward in the Health Center in Nis. The research period lasted from January 1st 1995 to June 1st 2010. The following parameters were recorded: the patients’ sex and age, fracture type and operation duration, blood compensation, application of antibiotics, pain, range of movement, muscle power, verticalization time, curtailment of the limb operated on, patients’ walk and activity after operation. Mechanic complications, superficial and deep infections, duration of hospitalization, mortality and final functional results were also recorded. The final treatment results were estimeted with Salvati-Wilson scale modified by Todorovic and Jevtic. The author has come to conclusions which are reliable and applicable. Momčilo Todorović – Doktorska disertacija Komparativna analiza rezultata lečenja trohanternih preloma - 187 - During the test of dynamization of the neck axis with cyclic loading applied on the femur model, the dynamization happens in an early phase in the case of all the three implants. During the testing process of the continual axial force at 1000N, none of the implants’ plastic is deformed. Apart from dynamization in the neck axis, existing in all the three extramedular implants, dynamization along the axis of the femur, existing in the selfdynamizing inner fixator-Mitkovic, has an advantage when we compare it with the other extramedular implants. According to the clinical research results, in the treatment of femur trochanteric fracture with dynamic extramedular implants (DHS-YU, selfdynamizing inner fixator Mitkovic, DHS-Richards) we can say that all the implants are anatomically and functionally very efficient. The treatment of trochanteric fractures treated with DHS-YU implants compared with the treatment of trochanteric fractures treated with DHS-Richards implants, shows that better results are achieved with DHS-implants if we consider patients’ supporter,walk and activity after operation. It has been confirmed that there is no great statistic difference in the analyzed parameters between patients who are treated with DHS YU extramedular implant and patients treated with selfdynamizing inner fixator – Mitkovic. The study results are very important for trochanteric fracture treatment applied on older patients

The comparative analysis of the results achieved in the trochanteric fracture treatment

This doctoral thesis deals with the current problem of osteoarticular system and trochanteric fracture treatment of people who are 60 or more years old. The fracture is treated by extramedular implants, DHS-YU, selfdynamizing fixator-Mitkovic and DHS-Richards. The thesis contains both experimental and clinical part of study. In the experimental part of the thesis, you can find a research carried out on biomechanic characteristics of the implants and dinamization at the axis neck under cyclic loading. Wooden femur models with virtual trochanteric fracture are used (under fracture corner of 45º) and they are fixed with a corresponding implant. At the Faculty of Engineering in Nis, a research was carried out with a specific instrument used for cyclic examination. It has been used for the implant testing since 2007. Wooden femur models are used for testing the implant resistence on the axial force. As an equipment part, we used a “twitcher” (Veb Thuringer Raunsteim). During the procedure we used power of 1000N. One hundred and fifty patients who were 60 or more years old, took part in the clinical prospective study.They all had a trochanteric fracture and were all treated with the dynamic extramedular implant, DHS-YU, self-dynamizing fixator-Mitkovic and DHS-Richards, at the orthopedic ward in Cuprija and at the orthopedic clinical ward in the Health Center in Nis. The research period lasted from January 1st 1995 to June 1st 2010. The following parameters were recorded: the patients’ sex and age, fracture type and operation duration, blood compensation, application of antibiotics, pain, range of movement, muscle power, verticalization time, curtailment of the limb operated on, patients’ walk and activity after operation. Mechanic complications, superficial and deep infections, duration of hospitalization, mortality and final functional results were also recorded. The final treatment results were estimeted with Salvati-Wilson scale modified by Todorovic and Jevtic. The author has come to conclusions which are reliable and applicable. Momčilo Todorović – Doktorska disertacija Komparativna analiza rezultata lečenja trohanternih preloma - 187 - During the test of dynamization of the neck axis with cyclic loading applied on the femur model, the dynamization happens in an early phase in the case of all the three implants. During the testing process of the continual axial force at 1000N, none of the implants’ plastic is deformed. Apart from dynamization in the neck axis, existing in all the three extramedular implants, dynamization along the axis of the femur, existing in the selfdynamizing inner fixator-Mitkovic, has an advantage when we compare it with the other extramedular implants. According to the clinical research results, in the treatment of femur trochanteric fracture with dynamic extramedular implants (DHS-YU, selfdynamizing inner fixator Mitkovic, DHS-Richards) we can say that all the implants are anatomically and functionally very efficient. The treatment of trochanteric fractures treated with DHS-YU implants compared with the treatment of trochanteric fractures treated with DHS-Richards implants, shows that better results are achieved with DHS-implants if we consider patients’ supporter,walk and activity after operation. It has been confirmed that there is no great statistic difference in the analyzed parameters between patients who are treated with DHS YU extramedular implant and patients treated with selfdynamizing inner fixator – Mitkovic. The study results are very important for trochanteric fracture treatment applied on older patients

Deficit i suficit selena u živine

Deficiencies of selenium in diet in poultry (below 0,15 mg/kg) lead to poor increasing, disturbance of health state and decreasing of reproductive capacities. The most frequent diseases caused by deficit of selenium are: exudative diathesis, pancreatic fibrosis and muscular dystrophy. Surplus of selenium can cause acute or chronic sclenosis. Acute selenosis is appeared when poultry take high levels of selenium in short time period. It is manifested by rapid breathing, vomiting, diarrhea, tetanus spasms and deaths occur due to suffocation. Chronic selenosis is appeared when poultry take diet containing more than 5 and less then 40 mg Se/kg in longer time period. It is shown by increase of concentration of Se in blood and muscles, reducing growth and increasing mortality at levels higher than 15 mg Se/kg diet. Level of selenoenzyme OSH-Px is not linear dependence to level above necessary, the activities of this enzyme show the effect of plateau, so that more selenium does not to further increasing of its activity.Deficit selena u hrani kod živine (ispod 0,15 mg/kg) dovodi do slabijeg prirasta, poremećaja zdravstvenog stanja i smanjenja reproduktivnih sposobnosti. Najčešća oboljenja prouzrokovana deficitom selena su: eksudativna dijateza, fibroza pankreasa i mišićna distrofija. Suficit selena kod živine može da izazove akutnu ili kroničnu selenozu. Akutna selenoza se javlja kada živina u kratkom vremenskom intervalu unese visoke nivoe selena. Ona se manifestuje ubrzanim disanjem, povraćanjem, dijareom, tetanusnim grčevima, a uginuća nastaju usled ugušenja. Hronična selenoza nastaje kada živina duži vremenski period unosi hranu koja sadrži više od 5 a manje od 40 mg Se/kg. Ona se manifestuje porastom Se u krvi i mišićima, smanjenim prirastom i povećanim mortalitetom pri nivoima višim od 15 mg Se/kg hrane. Nivo selenoenzima GSH-Px nije u linearnoj zavisnosti od nivoa selena u hrani. Pri povećanju nivoa iznad potrebnih, aktivnost ovog enzima pokazuje efekat platoa, tako da viši sadržaji selena ne dovode do daljeg povećanja njegove aktivnosti

Surgical treatment of tibial nonunion after wounding by high velocity missile and external fixators: A case report

Introduction. The missiles of modern firearms can cause severe fractures of the extremity. High velocity missile fractures of the tibia are characterized by massive tissue destruction and primary contamination with polymorphic bacteria. Treatment of these fractures is often complicated by delayed healing, poor position healing, nonhealing and bone tissue infection. Case Outline. We present the management of tibial nonunion after wounding by high velocity missile and primary treatment by external fixation in a 25-year-old patient. The patient was primarily treated with external fixation and reconstructive operations of the soft tissue without union of the fracture. Seven months after injury we placed a compression-distraction external fixator type Mitkovic and started with compression and distraction in the fracture focus after osteotomy of the fibula and autospongioplasty. We recorded satisfactory fracture healing and good functional outcome. Conclusion. Contamination and devitalization of the softtissue envelope increase the risk of infection and nonunion in fractures after wounding by high velocity missile. The use of the compression-distraction external fixator type Mitkovic may be an effective method in nonunions of the tibia after this kind of injury. [Projekat Ministarstva nauke Republike Srbije, br. III 41004

Zarządzanie rozwojem ekonomicznym: wybrane aspekty

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