Malignant fibrous histiocytoma of the femur - case report

U članku prikazujemo 33-godišnjeg pacijenta oboljelog od malignog fibroznoga histiocitoma lijevog femura. Bolesnik je primljen u našu ustanovu radi patološkog prijeloma proksimalnoga dijela lijevog femura. Nakon hospitalizacije učinjena je biopsija tumorozne tvorbe, te je dobivena dijagnoza malignog fibroznoga histiocitoma. Pacijent je upućen na kemoterapiju, te se po provedenom liječenju ponovno hospitalizira u našoj ustanovi. Tada se učini ekstirpacija tumora in toto, uz rekonstrukciju alogenim presadkom proksimalnoga femura i ugradnjom totalne revizijske endoproteze lijevoga kuka. Postoperacijski tijek protekao je uredno, a pacijent se vertikalizirao uz pomoć dvije dolaktične štake. Godinu dana po operativnom zahvatu prisutan je uredan položaj ugrađenog transplantata i ndoproteze, nema znakova recidiva, a pacijent samostalno obavlja svakodnevne životne aktivnosti.In this article we present the case of a 33-year-old patient with malignant fibrous histiocytoma of the left femur. The patient was admitted in our hospital due to pathological fracture of the left proximal femur. Upon admission, tumor biopsy was performed and malignant fibrous histiocytoma was confirmed. Chemotherapy and radiotherapy were performed prior to the second admission to our hospital. We performed extirpation of the tumor in toto and reconstruction with homotransplantat for proximal femur and implantation of total revision endoprothesis for the left hip. The postoperative course was without complications and the patient started walking with 2 crouches after surgery. A year after surgery there is an adequate postion of homotransplantat and endoprosthesis, there are no signs of relapse and the patient continues with normal daily activities

Croatian rotatory oblique three-dimensional osteotomy (CROTO) - a modified Wilson's osteotomy for adult hallux valgus intended to prevent dorsal displacement of the distal fragment and to reduce shortening of the first metatarsal bone

Aim: To evaluate biomechanical and clinical outcomes of a newly developed modification of the Wilson's osteotomy for hallux valgus: a three-dimensional subcaptial correction of the metatarsal head position with a simultaneous lateral and plantar shift with derotation intended to reduce displacement of the distal fragment and shortening of the first metatarsal bone. ----- Methods: Thirty four feet (28 female patients) underwent the new procedure and were evaluated before and 12 to 84 months (median=25.5) after the surgery. ----- Results: Plantar shift of the distal fragment was achieved in all feet. Shortening of the first metatarsal was moderate: ≤6 mm in 32/34 feet, 7 and 10 mm in the remaining two. Median difference in metatarsal index post- vs. pretreatment was -4.0. The hallux valgus angle, intermetatarsal and distal metatarsal articular angles were reduced in all feet. The American Orthopaedic Foot and Ankle Society score improved in all feet (median increase= 51.5). ----- Conclusion: The method allows for a lateral and plantar shift with derotation of the distal fragment and a mild/moderate shortening of the first metatarsal bone

Computer assisted total knee arthroplasty

Artroza koljena je najčešća degenerativna bolest zglobova čija se incidencija povećava starenjem populacije. U uznapredovaloj fazi bolesti liječenje artroze koljena obuhvaća ugradnju totalne endoproteze koljena. Dugotrajnost preživljenja totalne endoproteze koljena ovisi o ispravnoj pozicioniranosti komponenata endoproteze u sve tri ravnine, odnosno o rekonstrukciji biomehaničkih odnosa donjeg ekstremiteta. Pogreške u kirurškoj tehnici najčešći su razlog nepreciznosti ugradnje komponenti totalne endoproteze koljena. Razvojem instrumentarija poboljšavaju se rezultati ugradnje endoproteze koljena, a značajan napredak postiže se uvođenjem računalne navigacije u kirurgiju koljena 1997. godine. Virtualnim povezivanjem anatomskih struktura, prvenstveno koštane anatomije pacijenta, s računalnom slikom istoga, koristeći podatke slikovnih pretraga ili anatomske intraoperativne podatke, svaka je kirurška akcija prikazana na ekranu u realnom vremenu na računalno oblikovanom modelu. Virtualna trodimenzionalna reprodukcija koljena uz pomoć računala omogućava preciznije reseciranje zglobnih površina i ugradnju komponenti endoproteze koljena. Precizna pozicioniranost dijelova endoproteze i rekonstrukcija biomehaničkih odnosa omogućava brži oporavak, agresivniju fizioterapiju, a i sam vijek endoproteze je produljen, čime se smanjuju troškovi zdravstvenog sustava i povećava zadovoljstvo pacijenta.Knee osteoarthritis is the most common degenerative joint disease, whose incidence increases as populations age. In advanced stages, knee osteoarthritis disease treatment considers the implantation of a total knee endoprosthesis. Longterm survival of total knee endoprosthesis depends on the correct positioning of prosthesis components in all three planes, with respect to the reconstruction of the biomechanical relations of the lower extremities. Mistakes in surgical technique are the most common reason for inaccurate implantation of the total knee endoprosthesis components. The development of instruments for total knee arthroplasty enhanced the results of total knee arthroplasty and significant progress was achieved with the introduction of the computer navigation system in knee surgery in 1997. Virtual linking of anatomical structures, primarily the bone anatomy of the patient, with computer images of the same, using image search data or intraoperative anatomic data, each surgical action is displayed on the monitor in real time on a computer-shaped model. Virtual three-dimensional reproductions of the knee using a computer system enable accurate resection of the articular surface and precise implantation of total knee endoprosthesis components. The precise positioning of total knee endoprosthesis components and the reconstruction of the biomechanical relations allow faster recovery, aggressive physiotherapy, and longer survival of endoprosthesis which reduce the cost of the health system and increase patient satisfaction

The Influence of Test Repetition on Bipodal Visually Controlled Static and Dynamic Balance

This study explores the influence of test repetition on bipodal visually controlled balance, both static and dynamic. Our goal was to get an insight into the pattern of changes in posture maintenance results during repeated balance tests. Fifteen young, healthy male recreational athletes were tested for static and for dynamic balance using KAT 2000 balance platform. The subjects first performed three trial tests of static and dynamic balance to get used to the platform followed by seven repetitions of static as well as dynamic test which were recorded. During the repeated tests we could not determine any significant improvements of static balance test resulting from number of test repetitions neither in static nor in dynamic balance (Friedman ANOVA: Static balance p=0.497, Dynamic balance p=0.393). Correlating static and dynamic balance results we found that only one third of the dynamic balance was related to static balance abilities (r2=0.36). Possible patterns in front-back and left-right directions were analyzed as well, however, none of these balance scores were found to be related to the number of repetitions. In conclusion, this study found no significant influence of limited number of repetitions (seven) on test results in static and dynamic posture. However, as large number of repetitions might still influence test results we discourage the use of KAT 2000 as a training tool in patients in which it will be used as an instrument to validate postoperative rehabilitation or investigation results

Range of movement after total knee arthroplasty

Cilj: Cilj istraživanja bio je ispitati pokretljivost koljena nakon ugradnje totalne cementne endoproteze koljena. Metode: U razdoblju od rujna 2007. do prosinca 2008. kliničkim pregledom, odnosno mjerenjem opsega pokretljivosti goniometrom, analizirana je preoperativna pokretljivost koljena, pokretljivost koljena 14. postoperativni dan, te godinu dana nakon ugradnje totalne endoproteze koljena. Analizirane su one endoproteze kod kojih su komponente postavljene u neutralnom položaju, te kod kojih je uspostavljen dobar balans mekih česti. Analizirana je pokretljivost koljena 45 bolesnika operiranih u našoj ustanovi. Svim bolesnicima ugrađen je isti tip endoproteze i operirao ih je isti operacijski tim. Rezultati: Postoji statistički značajna razlika u prisutnosti preoperativne fleksorne kontrakture te fleksorne kontrakture godinu dana od operacije, no opsezi fleksije preoperativno i godinu dana nakon operacije su bez statistički značajne razlike, iako trend ukazuje na veću mogućnost fleksije godinu dana nakon operacije. Rasprava: Odgovarajućom operativnom tehnikom te provođenjem rehabilitacijskog postupka po standardnom protokolu postiže se pokretljivost dovoljna za svakodnevne životne aktivnosti. Pokretljivost godinu dana nakon operacije ukazuje na važnost fizikalne terapije po otpustu iz bolnice. Iako postoperativna pokretljivost koljena većinom ovisi o preoperativnoj pokretljivosti, a djelomično o tipu i pozicioniranosti endoproteze, rezultati naše studije ukazuju na značajnost kirurške tehnike i rane postoperativne kineziterapije. Zaključak: Najčešći razlog zbog kojeg se bolesnici odlučuju na ugradnju endoproteze koljena je bol i smanjena pokretljivost. U svih bolesnika bol je bio značajnije manjeg intenziteta, a postignuta pokretljivost godinu dana nakon operacije bila je dovoljna za ostvarivanje svakodnevnih životnih aktivnosti.Aim: To determine the range of motion after implantation of total cement knee endoprosthesis. Methods: In the period form Septemer 2007 to December 2008 range of motion was measured during clinical exam with protractor. Range of motion was analysed preoperatively, 14th day postoperatively and a year postoperatively. We analysed the prosthesis where the components were placed in a neutral position, and where a good balance of soft tissue was established. Mobility of the knee of 45 patients operated in our institution was analyzed. Same type of prosthesis was implanted to all patients, and the same operating team performed the surgeries. Results: There are signifi cant diff erences in the presence of preoperative flexion contracture and flexion contracture a year after the surgery. The extent of flexion preoperative and one year after surgery were without significant differences, although the trend indicates a greater ability of flexion one year after surgery. Discussion: Appropriate operative technique and rehabilitation process by standard protocol enable mobility which is suffi cient for daily life activities. Mobility one year after surgery indicates the importance of physical therapy after discharging from hospital. Although postoperative mobility of the knee mainly depends on preoperative mobility, and partly on the type and position of endoprosthesis, the results of our study indicate the importance of surgical technique and early postoperative kinesiotherapy. Conclusion: The most common reasons for patients to decide for total knee arthroplasty are pain and reduced mobility. In all patients, pain was of signifi cantly lower intensity, and mobility achieved one year of operations was sufficient to overcome daily living activites

Infections of the musculoskeletal system – review article

Uvod: Infekcije lokomotornog sustava mogu se podijeliti u nekoliko osnovnih skupina ovisno o lokalizaciji, vremenu trajanja i prisutnosti stranog materijala. Kirurške infekcije povećavaju morbiditet i mortalitet bolesnika, financijski trošak liječenja te predstavljaju golemi globalni javnozdravstveni problem. Liječenje infekcija lokomotornog sustava može biti antibiotsko ili kirurško, a najčešće je potrebno kombinirati ove dvije metode. Cilj rada: Cilj je ovog rada dati pregled infekcija lokomotornog sustava s kojima se susreću ortopedi i traumatolozi u svojem radu, uz pregled suvremene literature dostupne na ovu temu. Rasprava: U raspravi su prikazane sve infekcije lokomotornog sustava i za svaku su opisane klinička slika, dijagnostika i suvremene opcije liječenja. Zaključak: Možemo zaključiti da su sve infekcije mišićno-koštanog sustava potencijalno vrlo teška stanja koja, ako se na vrijeme ne prepoznaju i ne liječe, mogu završiti trajnom invalidnošću, daljnjim hematogenim širenjem bakterija i razvojem sepse, pa čak i smrću bolesnika.Introduction: Infections of the musculoskeletal system can be divided into several basic groups depending on localization, duration and the presence of foreign material. Surgical infections increase the morbidity and mortality of patients, the financial cost of treatment, and represent a huge public health problem globally. Treatment of musculoskeletal infections can involve the use of antibiotics or surgery, and most often it is necessary to combine these two methods. Aim: The aim of this paper is to provide an overview of the musculoskeletal infections that orthopedic and trauma surgeons encounter in their work, along with an overview of the literature available on this topic. Discussion: In the discussion, all infections of the musculoskeletal system are presented individually and the clinical presentation, diagnostics and modern treatment options are described for each. Conclusion: We can conclude that all infections of the musculoskeletal system are potentially very serious conditions that, if not recognized and treated in time, can end in permanent disability, further hematogenous spread of bacteria and the development of sepsis, and even the death of the patien

Open Total Talar Dislocation with Extrusion (Missing Talus)

Open total dislocation of a talus with extrusion (missing talus) is an extremely rare injury. We present a case of a 63-year-old male who sustained an open total lateral dislocation of the right talus with extrusion and without a concomitant fracture after a fall from a small height. Tibiocalcaneonavicular arthrodesis was performed. Arthrodesis failed, and due to painfull and unstable ankle, rearthrodesis was performed two years later, successefully. Because of rarity of this kind of injury, hers importance for foot function, previously described various treatment options and absence of guidelines, herewith we propose, according to our experience and review of literature, the algoritham for the treatment of this rare injury