19 research outputs found
Ishodi kirurÅ”kog lijeÄenja dislociranih prijeloma oba stupca acetabuluma
Complex both-column acetabulum fractures are severe injuries, often with associated
injuries and complications with uncertain clinical and functional outcome. Modern traumatological
protocols point to early surgical treatment, with anatomical reduction and stable internal fixation of fragments
as a prerequisite for achieving a good treatment outcome. This retrospective-prospective multicenter
cohort study was conducted during the 2014-2020 period and included 24 cases that met the input
parameters, using the Letournel and Judet classification, and application of a combined surgical approach,
a modified Stoppa and Kocher-Langenbeck approach. The results of treatment with complications, associated
injuries and functional outcome are described. Fractures were caused by high kinetic energy trauma,
and the cause was traffic accident in 17/24 (70.84%), fall from a height in 5/24 (20.83%) and crash
injuries in 2/24 (8.33%) cases. The sample included 18 (75.00%) male and 6 (25.00%) female, with 10/24
(41.67%) right sided and 14/24 (58.33%) left sided fractures. Their mean age was 45.06 (range, 24-62)
years. The mean follow-up time was 2.8 (range, 1-5) years. Postoperative complications were detected in
14/24 (58.33%) cases, including wound infection in 4/24 (16.67%), deep vein thrombosis in 2/24 (8.33%),
heterotopic ossification in 2/24 (8.33%), hip osteoarthrosis in 3/24 (12.50%), avascular necrosis of femoral
head in 2/24 (8.33%), total hip arthroplasty procedures in 3/24 (12.50%), abdominal complications
in 2/24 (8.33%), urologic complications in 2/24 (8.33%), iatrogenic nerve lesion in 3/24 (12.50%), and
fatal pulmonary embolism in 2/24 (8.33%) cases; there was no loss of reduction or non-union acetabular
fracture. Associated injuries that we recorded as major trauma were presented in 13/24 (54.17%) study
patients. The final functional results according to the Harris Hip Score (HHS) were excellent in 7/22
(31.82%), good in 10/22 (45.45%), moderate in 4/22 (18.18%) patients, and poor in 1/22 (4.55%) patient.
The mean HHS was 84 (range 34-98). Complications and results have led us to a conclusion that primary
injuries significantly affect the clinical and functional results. A good diagnostic procedure, assessment of
the general condition and application of the trauma scoring system, surgical treatment that includes early
hip reduction, open reduction internal fixation and physical rehabilitation are necessary.Složeni prijelomi oba stupa acetabuluma teÅ”ke su ozljede, Äesto praÄene pridruženim ozljedama i komplikacijama s neizvjesnim
kliniÄkim i funkcionalnim ishodom. Suvremeni traumatoloÅ”ki protokoli ukazuju na rano kirurÅ”ko lijeÄenje s anatomskom
repozicijom i stabilnom unutarnjom fiksacijom fragmenata kao preduvjet za postizanje dobrog ishoda lijeÄenja. Ova
retrospektivno-prospektivna multicentriÄna kohortna studija provedena je u razdoblju od 2014. do 2020. godine i ukljuÄila
je 24 sluÄaja koji su zadovoljili ulazne parametre prema klasifikaciji Letournela i Judeta. Primijenjen je kombinirani kirurÅ”ki
pristup, tj. modificirani pristup Stoppe i Kocher-Langenbecka. Prikazuju se rezultati lijeÄenja, komplikacije, pridružene ozljede
i funkcionalni ishod. Prijelomi su nastali djelovanjem traume visoke kinetiÄke energije, a uzrok je bila prometna nesreÄa
u 70,84% (17/24), pad s visine u 20,83% (5/24) i ozljede u sudaru u 8,33% (2/24) sluÄaja. Uzorak je obuhvatio 18 (75,00%)
muŔkaraca i 6 (25,00%) žena s 41,67% (10/24) desnostranih i 58,33% (14/24) lijevostranih prijeloma. Srednja dob ispitanika
bila je 45,06 (raspon 24-62) godina. Srednje vrijeme praÄenja bilo je 2,8 (raspon 1-5) godina. Poslijeoperacijske komplikacije
zabilježene su kod 58,33% (14/24) ispitanika, ukljuÄujuÄi infekciju rane u 16,67% (4/24), duboku vensku trombozu u 8,33%
(2/24), heterotopiÄnu osifikaciju u 8,33% (2/24), osteoartrozu kuka u 12,50% (3/24), avaskularnu nekrozu glave femura u
8,33% (2/24), totalnu artroplastiku kuka u 12,50% (3/24), abdominalne komplikacije u 8,33% (2/24), uroloŔke komplikacije
u 8,33% (2/24) ), jatrogenu leziju živaca u 8,33% (3/24), smrtonosnu pluÄnu emboliju u 8,33% (2/24), dok nismo imali gubitak
redukcije i nesrastanje prijeloma. Pridružene ozljede zabilježene su kod 54,17% (13/24) ispitanika. KonaÄni funkcionalni
rezultati prema Harris Hip Score (HHS) bili su odliÄni u 31,82% (7/22), dobri u 45,45% (10/22), umjereni u 18,18% (4/22)
te loÅ”i u 4,55% (1/22) ispitanika. Srednja vrijednost HHS bila je 84 (raspon 34-98) bodova. Komplikacije i rezultati upuÄuju
na zakljuÄak da težina primarne ozljede znaÄajno utjeÄe na kliniÄki i funkcionalni rezultat. Potreban je dobar dijagnostiÄki
postupak, procjena opÄeg stanja i primjena bodovnog sustava traume, kirurÅ”ko lijeÄenje koje podrazumijeva pravodobnu
repoziciju kuka, otvorenu redukciju sa stabilnom unutarnjom fiksacijom prijeloma te fizikalnu rehabilitaciju
Osteomyelitis and septic arthritis in children and adolescents
UzroÄnici, epidemiologija, dijagnostika pa i lijeÄenje septiÄkog artritisa i osteomijelitisa u djece su se posljednjih godina promijenili. NajÄeÅ”Äi uzroÄnik ostaju bakterije i to i dalje Staphyloccocus aureus dok je Haemophilus influenzae nakon uvoÄenja obaveznog cjepiva gotovo nestao. Standardno lijeÄenje je i dalje empirijska antibiotska terapija u kombinaciji s kirurÅ”kim zahvatima. Nove sheme antibiotskog lijeÄenja predviÄaju samo nekoliko dana parenteralne primjene nakon Äega slijedi peroralno lijeÄenje. KirurÅ”ki zahvati iako u opadanju i dalje imaju važno mjestu u lijeÄenju i to ponajviÅ”e dekompresijske procedure. Danas je smrtnost samo oko 1%, meÄutim Äak i uz adekvatno lijeÄenje, mogu zavrÅ”iti destrukcijom zgloba i ploÄe rasta, skraÄenjem i angularnim deformacijama ekstremiteta i znaÄajnim invaliditetom.Causative pathogens, epidemiology, diagnosis, and treatment of pediatric septic arthritis and osteomyelitis have changed remarkably over the past decade. Bacteria remain the most common pathogens, especially Staphylococcus aureus, while Haemophilus influenzae virtually perished after the introduction of obligatory vaccination. Empiric antibiotic therapy in combination with surgery remains the standard treatment. The trend of short-term course of parenteral antibiotic therapy followed by oral administration is observed in recent literature. Surgeries are still conducted, mostly decompression procedures. The mortality is around 1%, but even if adequate treatment is conducted, infectious diseases of locomotor system may lead to the destruction of the joint and growth plate, shortage and angular deformity of the extremity and substantial disability
Incarcerated Diaphragmatic Hernia ā Differential Diagnoses
The incarceration of diaphragmatic hernia is very rare. We present a case of a four-year old girl who developed the
incarceration of left-sided diaphragmatic hernia, who, until then, was completely asymptomatic. This incarceration of
the hernia represented a surgical emergency presenting as obstructive ileus and a severe respiratory distress which developed
from what appeared to be full health. During a brief pre-operative examination a number of differential diagnoses
were suggested. Along with the laboratory blood analysis (complete blood count and acid-base balance) a plain thoracic
and abdominal radiography was done (babygram). After that, through an inserted nasal-gastric tube, barium meal of
the upper gastrointestinal tract was done, showing abdominal organs in the left half of the thorax and a signifi cant shift
of the mediastinum to the right. With an urgent upper medial laparotomy we accessed the abdominal cavity and made
the correct diagnosis. An opening was shown in the rear part of the left hemi-diaphragm with thickened and edematous
edges, approx. 6 cm in diameter with incarcerated content. The incarcerated abdominal organs (stomach, transversal
colon, small intestine and spleen) gradually moved into the abdominal cavity. The opening was closed with nonresorptive
sutures (TiCron) size 2-0 with a previous control and ventilated expansion of the well-developed left lung. In postoperative
course the acid-base balance quickly recovered, as well as the general state of the patient and radiography showed a good
expansion and lucency of the lung parenchyma and a return of the mediastinum into the middle part of the thorax
EPIDURALNA ADHEZIOLIZA U LIJEÄENJU KRONIÄNE KRALJEŽNIÄKE BOLI KOD SINDROMA NEUSPJELE OPERACIJE KRALJEŽNICE I KOD LUMBALNE RADIKULARNE BOLI: JEDNOGODIÅ NJE ISKUSTVO U OPÄOJ BOLNICI PULA
Aim. The aim was to evaluate the effi cacy and feasibility of percutaneous adhesiolysis to reduce pain, improve daily functions and reduce drug use in patients with chronic pain. Chronic radicular pain can be caused by scar tissue, compression, infl ammation, or swelling disks. Adhesiolysis by placement of a wire-bound catheter into the ventrolateral aspect of the epidural space at the site of the exiting nerve root enables precise application of steroids, hyaluronidase, local anesthetics and saline for to achieve pain relief. Methods: Standard percutaneous epidural adhesiolysis was performed in 54 patients divided into two groups: pain from failed back surgery syndrome (FBSS) versus chronic radicular pain without previous spine surgery. Visual analog scale (VAS) score, change in pharmacotherapy used, subjective satisfaction and evaluation of the lysis procedure were observed in pretreatment, and then in the 4th and 12th week of the intervention. Results: VAS scores for pain were signifi cantly reduced in both groups in the 4th and 12th week. A statistically signifi cant decrease was expressed in the radiculopathy group (VAS0=7.5Ā±0.87/VAS12th=4.6Ā±1.05) versus FBSS group (VAS0=7.6Ā±0.85/VAS12th=5.0Ā±1.58) (p50% was achieved in 27% of FBSS patients and 25% of patients with chronic radicular pain without surgery experience. Conclusion: Considering the small sample size, our results in short-term pain relief suggested that epidurolysis could be an effective method in the treatment of patients with chronic radicular pain as in patients with FBSS.Cilj: Cilj ove randomizirane studije bila je procjena izvodivosti i uÄinkovitosti adheziolize u lijeÄenju kroniÄne kralježniÄke boli, njezin utjecaj na poboljÅ”anje kvalitete života, odnosno njezin uÄinak na kroniÄnu analgetsku terapiju. Epiduralna adhezioliza omoguÄava postavljanje posebno dizajniranih katetera u ventrolateralni aspekt epiduralnog prostora, tj. u neposrednoj blizini izlazaÄeg živÄanog korijena i preciznu primjenu steroida, hijaluronidaze i lokalnih anestetika u cilju smanjenja fenomena boli. Metoda: U studiju su uskljuÄena 54 bolesnika podijeljena u dvije skupine: bolesnici s kroniÄnom boli nakon neuspjele kralježniÄke operacije (FBSS) naspram bolesnika s kroniÄnom radikularnom boli bez prethodnog kirurÅ”kog iskustva. Nakon 4. odnosno 12. tjedna od postupka praÄene su promjene u vizualno analognoj ljestvici boli (VAS), u farmakoterapijiskom unosu, u stupnju subjektivnog životnog zadovoljstva bolesnika, kao i procjena ukupnog uÄinka adheziolize. Rezultati: ProsjeÄna razina boli (VAS) bila je znaÄajno smanjena u obje skupine i u 4. i u 12. tjednu. StatistiÄki znaÄajno smanjenje izraženo je u skupini radikulopatije (VAS 0 = 7,5 0,87 / VAS 12th = 4,6 1,05) u odnosu na FBSS skupinu (VAS 0 = 7,6 0,85 / VAS 12th = 5,0 1,58) (p 50 % smanjenja inicijalne boli iskazala se u 27 % pacijenata s FBSS i u 25 % bolesnika s kroniÄnom radikularnom boli. ZakljuÄak: S obzirom na naÅ” mali uzorak, ostvareni rezultati u kratkoroÄnom ublažavanju boli ukazuju da epiduralna adhezioliza može biti uÄinkovita metoda u lijeÄenju bolesnika s kroniÄnom radikularnom boli kao Å”to je to u bolesnika s FBSS
Dislocated Left Knee Injury and Popliteal Arteries of the Left Knee
The bone and joint injuries include fractures of the extremities, sprains and strains of joints. The
complications that threaten the vitality of the limb or permanently damage its functions have been reported in a small percentage of injuries of extremities. The biggest threat to the limb are threatening injuries blood supply, primarily direct injury artery or sometimes vein. Closed injuries can cause ischemia by interruption of arterial
blood supply, as is the case at the back sprains knee, hip and supracondylar humerus fractures with displacement.
In our case, the rear dislocation of the knee led to the injury of artery with ischemia on the periphery of the left leg , and the only timely diagnosis and surgery, the patient was saved foot
Dislocated Left Knee Injury and Popliteal Arteries of the Left Knee
The bone and joint injuries include fractures of the extremities, sprains and strains of joints. The
complications that threaten the vitality of the limb or permanently damage its functions have been reported in a small percentage of injuries of extremities. The biggest threat to the limb are threatening injuries blood supply, primarily direct injury artery or sometimes vein. Closed injuries can cause ischemia by interruption of arterial
blood supply, as is the case at the back sprains knee, hip and supracondylar humerus fractures with displacement.
In our case, the rear dislocation of the knee led to the injury of artery with ischemia on the periphery of the left leg , and the only timely diagnosis and surgery, the patient was saved foot
Prikaz sluÄaja 17-godiÅ”nje djevojke s okluzijom lijeve poplitealne i desne radijalne arterije
This is a case of a 17-year old girl with right radial and left popliteal arterial occlusion. This was diagnosed with
clinical examination, arterial colour doppler and pletismography. For further evaluation this girl was refered to KBC Zagreb,
Pediatric clinic and Clinic for heart and coronary deseases where she was diagnosed with antiphospholipidal syndrome. Her
laboratory parameters tested positive for lupus anticoagulant. Digital subtraction angiography confirmed the colour dopler
results