Morphological changes of the proximal part of the body of thight bone in patients with coxarthosis

U bolesnika s uznapredovalim degenerativnim promjenama zgloba kuka istraživane su morfološke promjene proksimalnog dijela trupa bedrene kosti. Pregledom je obuhvaćeno 454 zgloba kuka bolesnika liječenih u Odjelu za ortopediju Opće bolnice u Osijeku i Klinici za ortopediju Medicinskog fakulteta Sveučilišta u Zagrebu. Većini bolesnika je ugrađena totalna endoproteza. Podaci dobiveni morfometrijskim mjerenjima na radiogramima, te anamncstički i klinički podaci uneseni su u specijalno izrađeni upitnik, a potom su obrađeni pomoću računara. Istraživanjima je dokazano da u bolesnika s koksartrozom i postraničnim šepanjem u kuku dolazi do vertikalizacije rezultirajuće sile optere­ ćenja zgloba kuka, što uzrokuje morfološke promjene trupa bedrene kosti. U radu se daju morfometrijske karakteristike i shematski prikaz »standardnog femura« naše populacije u frontalnoj ravnini u bolesnika s koksartrozom.Morphological changes of the proximal part of the body of thigh bone in patients with advanced degenerative changes of the hip were observed. As an effect of the degenerative disease, the sideways limping of a predominantly antalgesic type was present in all cases. Our examination included 454 hip joints of patients treated in the Orthopaedic Department of the General Hospital in Osijek and the Orthopaedic Clinic of the Medical Faculty — University of Zagreb. Most of the patients had a total endoprothesis implanted. The data obtained by morphometrical measurements as well as anamnestic and clinical ones were recorded into specially performed questionnaires and then elaborated by computors. The research proved that the patients with coxarthrosis and sideways limping in the hip developed a verticalization of the resulting force of weightbearing of the joint, which caused morphological changes of the body of thigh bone. The research comprehended morphometrical characteristics and a schematic survey of »the standard femur« of our population on a frontal level in patients with coxarthrosis

Morphological changes of the proximal part of the body of thight bone in patients with coxarthosis

U bolesnika s uznapredovalim degenerativnim promjenama zgloba kuka istraživane su morfološke promjene proksimalnog dijela trupa bedrene kosti. Pregledom je obuhvaćeno 454 zgloba kuka bolesnika liječenih u Odjelu za ortopediju Opće bolnice u Osijeku i Klinici za ortopediju Medicinskog fakulteta Sveučilišta u Zagrebu. Većini bolesnika je ugrađena totalna endoproteza. Podaci dobiveni morfometrijskim mjerenjima na radiogramima, te anamncstički i klinički podaci uneseni su u specijalno izrađeni upitnik, a potom su obrađeni pomoću računara. Istraživanjima je dokazano da u bolesnika s koksartrozom i postraničnim šepanjem u kuku dolazi do vertikalizacije rezultirajuće sile optere­ ćenja zgloba kuka, što uzrokuje morfološke promjene trupa bedrene kosti. U radu se daju morfometrijske karakteristike i shematski prikaz »standardnog femura« naše populacije u frontalnoj ravnini u bolesnika s koksartrozom.Morphological changes of the proximal part of the body of thigh bone in patients with advanced degenerative changes of the hip were observed. As an effect of the degenerative disease, the sideways limping of a predominantly antalgesic type was present in all cases. Our examination included 454 hip joints of patients treated in the Orthopaedic Department of the General Hospital in Osijek and the Orthopaedic Clinic of the Medical Faculty — University of Zagreb. Most of the patients had a total endoprothesis implanted. The data obtained by morphometrical measurements as well as anamnestic and clinical ones were recorded into specially performed questionnaires and then elaborated by computors. The research proved that the patients with coxarthrosis and sideways limping in the hip developed a verticalization of the resulting force of weightbearing of the joint, which caused morphological changes of the body of thigh bone. The research comprehended morphometrical characteristics and a schematic survey of »the standard femur« of our population on a frontal level in patients with coxarthrosis

Pain therapy after lumbar discectomy

Cilj: Svrha istraživanja utvrditi je moguću prednost primjene Tramadoluma, Diclofenacuma i Dexamethasonuma u liječenju postoperacijskog bola nakon lumbalne discektomije u odnosu na uobičajenu postoperacijsku primjenu Tramadoluma i Metamizolum Natricuma. Metode: Istraživanjem je obuhvaćeno 46 ispitanika prosječne životne dobi od 45.29 ± 14.06 godina. U svih ispitanika učinjena je otvorena lumbalna discektomija. U prvoj skupini od 23 bolesnika postoperacijski su primjenjivani Tramadolum i Metamizolum Natricum, a kod druge skupine od 23 bolesnika Tramadolum, Dexamethasonum i Diclofenacum. Obrazac za praćenje postoperacijskog bola sastojao se iz dva dijela: prvog, koji je ispunjavao liječnik i koji je sadržavao podatke o kliničkom nalazu, dok je drugi dio obrasca ispunjavao bolesnik i bilježio podatke o preoperacijskom bolu te bolne smetnje dva dana i osam dana nakon operacije, stupnjujući ih prema skali od 0 do 10. U statističkoj obradi rabljen je program Statistica 5.0. Značajnost razlika određivana je Studentovim t-testom za nezavisne uzorke, dok se značajnost razlika između pojedinih uzoraka s obzirom na bolnost i vrijeme anketiranja utvrđivala Studentovim t-testom za zavisne uzorke. Rezultati: Rezultati istraživanja neovisno o mjerenju preoperacijskog bola govore da skupina ispitanika tretirana Tramadolumom, Dexamethasonumom i Diclofenacumom ima značajno manju bolnost u području noge (p < 0.01), dok je bolnost u križima nešto manja, još uvijek u području statističke značajnosti (p = 0.03; p = 0.01) u odnosu na skupinu ispitanika tretiranih Tramadolumom i Metamizolum Natricumom. Rasprava: Rezultati istraživanja potvrđuju učinkovitost i prednost kombinirane primjene Tramadoluma, Diclofenacuma i Dexamethasonuma u kupiranju postopercijskog bola nakon lumbalne discektomije u odnosu na primjenu Tramadoluma i Metamizolum Natricuma.Aim: The aim is to determine possible advantage of application of Tramadolum, Diclofenacum and Dexamethasonum in therapy of postoperative pain after lumbar discectomy in relation to standard postoperative application of Tramadolum and Metamizolum Natricum. Methods: The research covered 46 patients with mean age of 45.29 ± 14.06. All patients underwent open lumbar discectomy. The first group, consisting of 23 patients, was treated with Tramadolum and after the surgery , and the other one, also with 23 patients, was treated with Tramadolum, Dexamethasonum and Diclofenacum. The VAS questionnaire of postoperative pain consisted of two parts: the first one, filled in by a surgeon, included clinical findings, and the second one, filled in by a patient, contained data entered by the patient on postoperative pains and painful discomforts two and eight days after the surgery, with the scale from 0 to 10. Statistical 5.0 programme was used in statistical analysis. Statistical significance of differences was determined by Student’s independent samples T-test, while significance of differences between individual samples in respect of pain and time of filling in the questionnaire was determined by Student’s dependent samples T-test. Results: The research results, not considering measurement of preoperative pain, show that the group treated with Tramadolum, Dexamethasonum and Diclofenacum experienced significantly lower pain in the leg area (p< 0.01), while pain in sacral area was somewhat lower but still with statistical significance (p = 0.03; p = 0.01) compared to the group receiving Tramadolum and Metamizolum Natricum. Conclusion: The research results confirm efficiency and advantage of combined therapy with Tramadolum, Diclofenacum and Dexamethasonum in coping with postoperative pain after lumbar discectomy compared to the therapy with Tramadolum and Metamizolum Natricum

Mehanical complications in total hip joint endoprosthesis implantation

Ugradnja totalnih endoproteza zgloba kuka praćena je određenim brojem mehaničkih komplikacija. Analizom radioloških snimaka 250 totalnih endoproteza zgloba kuka (SAS, AHS, Muller) prikazanje položaj acetabulame i femoralne komponente ugrađenih endoproteza. Mjerenjima je ustanovljeno daje nagib ugrađenih acetabula u 44,4% bolesnika iznosio 41 do 50 stupnjeva, odnosno, u 75,6% bolesnika acetabul je imao kut nagiba od 36 do 55 stupnjeva. Trup je endoproteze bio u neutralnom položaju u 84,4% bolesnika. Varusni je položaj stema nađen u 7,2% bolesnika, a valgusni položaj u 8,4% bolesnika. Usavršavanje operacijske tehnike nepobitno je glavni čimbenik pri smanjenju broja mehaničkih komplikacija prilikom ugradnji totalnih endoproteza zgloba kuka.Implantation of total hip endoprosthesis may be accompanied by a number of mechanical complications. Radiographics images of 250 total hip endoprostheses (SAS, AHS, Muller) show the positions of acetabular and femoral components of implanted endoprostheses. Measurements have shown that the decline of implanted acetabulum ranged from 41 to 50 degrees in 44.4% of patients, i. e. in 75.6% of patients the angle of acetabular decline ranged from 36 to 55 degrees. The position of endoprosthesic shaft was neutral in 84.4% of patients; 7.2% of patients had varus position of the stem of shaft, whereas 8.4% of them had valgus shaft position. Improvement in operative technique is undoubtedly the major factor contributing to a decreased number of mechanical complications in total hip joint endoprosthetic implantation

Mehanical complications in total hip joint endoprosthesis implantation

Ugradnja totalnih endoproteza zgloba kuka praćena je određenim brojem mehaničkih komplikacija. Analizom radioloških snimaka 250 totalnih endoproteza zgloba kuka (SAS, AHS, Muller) prikazanje položaj acetabulame i femoralne komponente ugrađenih endoproteza. Mjerenjima je ustanovljeno daje nagib ugrađenih acetabula u 44,4% bolesnika iznosio 41 do 50 stupnjeva, odnosno, u 75,6% bolesnika acetabul je imao kut nagiba od 36 do 55 stupnjeva. Trup je endoproteze bio u neutralnom položaju u 84,4% bolesnika. Varusni je položaj stema nađen u 7,2% bolesnika, a valgusni položaj u 8,4% bolesnika. Usavršavanje operacijske tehnike nepobitno je glavni čimbenik pri smanjenju broja mehaničkih komplikacija prilikom ugradnji totalnih endoproteza zgloba kuka.Implantation of total hip endoprosthesis may be accompanied by a number of mechanical complications. Radiographics images of 250 total hip endoprostheses (SAS, AHS, Muller) show the positions of acetabular and femoral components of implanted endoprostheses. Measurements have shown that the decline of implanted acetabulum ranged from 41 to 50 degrees in 44.4% of patients, i. e. in 75.6% of patients the angle of acetabular decline ranged from 36 to 55 degrees. The position of endoprosthesic shaft was neutral in 84.4% of patients; 7.2% of patients had varus position of the stem of shaft, whereas 8.4% of them had valgus shaft position. Improvement in operative technique is undoubtedly the major factor contributing to a decreased number of mechanical complications in total hip joint endoprosthetic implantation

Spontaneous Regression of Intervertebral Disc Herniation – Case Reports

Lumbar disc hernia (LDH) is a common cause of low back pain and radicular leg pain. It is well known that the majority of LDH patients recover spontaneously. Since the advent of MRI, a spontaneous regression of fragment size of disc hernia occurs, as well as mitigation of subjective difficulties and neurological disorders. Therefore, surgical treatment is not always method of choice in this disease. Two cases of conservatively treated large disc extrusion which result in significant reduction of difficulties, with simultaneous reduction in fragment size of hernia which is documented by MR

Spontaneous Regression of Intervertebral Disc Herniation – Case Reports

Lumbar disc hernia (LDH) is a common cause of low back pain and radicular leg pain. It is well known that the majority of LDH patients recover spontaneously. Since the advent of MRI, a spontaneous regression of fragment size of disc hernia occurs, as well as mitigation of subjective difficulties and neurological disorders. Therefore, surgical treatment is not always method of choice in this disease. Two cases of conservatively treated large disc extrusion which result in significant reduction of difficulties, with simultaneous reduction in fragment size of hernia which is documented by MR

Advantages of Modified Osteosynthesis in Treatment of Osteoporotic Long Bones Fractures – Experimental Model

In surgery of fractured long bones, a patient suffering from osteoporosis represents constant challenge to a surgeon and applied material and instruments that need to destroy as little as possible of an already damaged bone. One potential way of increasing the contact surface between the implants and osteoporotic bone is injection of bone cement (methyl-metacrilat, Palakos) into a prepared screw bed. This method of osteosynthesis was therefore subjected to experimental research to prove that application of modified osteosynthesis using bone cement in treatment of fractures in osteoporotic patients has advantage over the standard method of osteosynthesis because this modified method enables significantly greater firmness and stability of the osteosynthesis, which is the essential precondition of a successful fracture healing. The research was carried out on six macerated cadaveric preparations of a shin bone from the osteological collection from Institute for Anatomy, School of Medicine, University »J. J. Strossmayer«. All samples of long bones were artificially broken in the middle part of the diaphysis and then standard osteosynthesis and modified osteosynthesis with screws filled with bone cement were performed on the samples. Results show that under identical static action of the moment of torsion in the modified osteosynthesis torsion angle deviation is lower than in the standard osteosynthesis. In modified osteosynthesis with bone cement the first results for angle of torsion deviation greater than 0.2 degrees were noticed after 120 minutes, while in the standard method of osteosynthesis they were noticed already in the first minute

A Validity of Ultrasound Subdivision of Risser Grade 4 in Assessment of Skeletal Maturity

In the treatment of adolescent idiopathic scoliosis, one of the most frequently used technique to determine skeletal ma- turity is the method described by Risser. The ossification of iliac apophysis progresses from ventral to caudal through the four zones and the fusion of the iliac apophysis to the iliac crest (Risser grade 5) indicated vertebral growth completion, therefore the termination of scoliotic deformity progression. The main disadvantages of Risser method are exposure to radiation and the questionable reliability, so there are efforts to examine iliac apohysis by ultrasound. There is also no resolute recommendation when to discontinue brace treatment of scoliosis. Using ultrasound, in this study, we subdi- vided Risser grade 4 to grade 4a and 4b, according to the amount of cartilage left unossified, in order to make clear when is safe to end brace treatment. We measured increase in height, during six month period, for 92 healthy children, who were classified by ultrasound in Risser 4a or 4b group. There was significantly larger increase in height for group 4a (p<0.001). For girls, we also noted time past from menarche as sign of biological maturity. Girls from group Risser 4b got menarche 2.74 years before they were examined while group Risser 4a got menarche only 1.57 years before (p<0.001). Subdvision of Risser 4 grade by ultrasound is promising method in determining end of brace treatment for scoliosis

Clinical Importance of Changes to Femoral Bone Mineral Density around the Hip Endoprosthesis

The implanting of a hip endoprosthesis changes the mechanical loading in a hip. The changing in loading causes bone remodeling. The loss of loading leads to bone atrophy, whereas an increase in loading leads to hypertrophy of the bones.We investigated the relationship between the clinical result and change in periprosthetic bone mineral density. The Harris hip score was used to measure the clinical outcome. The dual photon densitometry method was used to measure periprosthetic bone mineral density. The obtained results showed that a loss in bone mass around the hip endoprosthesis does not affect the clinical outcome of the operation. Bone hypertrophy has a positive effect on the clinical outcome. The patient’s age, sex and body weight in the investigated population did not have an negative impact on functional status. The time passing from the operation to measuring had a negative impact on the functional status