Institution: Centro Hospitalar Tondela Viseu

Country: Portugal

E-mail: zicogoncalves@gmail.com

Title: Snapping Shoulder Clinical case

Abstract: Shoulder microinstabilities are a group of disorders with multifactorial etiology, which may be divided according to their traumatic or atraumatic origin. These are a diagnostic and therapeutic challenge, because they often occur with normal physical examination and diagnostic tests. A 22 year-old caucasian male, bodybuilder. Is admited to our hospital with complaints compatible with snapping shoulder, and the feeling of instabiliade in the limits of external rotation in abduction, particularly when associated with load. Physical examination shows limitation in external rotation, with positive apprehension test for anterior instability. The patient underwent arthroscopy of the shoulder and we have indentified a fragment of cartilage from the posterior border of the glenoid , a posterior labrum injury with pedicle intraarticular fragments, as well as a detachment of lambrum. The fragment was excised and the anterior labrum was fixed with two anchors. The patient was discharged on the same day, and startde or active mobilization of the shoulder, unloaded for a 4 week period. He was seen periodically in consultation with resolution of initial symptoms soon after surgery. After the initial discharge, he resumed training with progressively increasing load. At 3 months after surgery he is asymptomatic, without any limitation. This type of pathology has an initial presentation difficult to characterize, and often, can only be better defined after careful arthroscopic evaluation. In this case, the authors admit that the injury has been traumatic, associated with the load exerted on the limits of the shoulder mobility during intensive practice of bodybuilding. The arthroscopy allows the identification and treatment of lesions that would otherwise be difficult or impossible to identify and treat. The advantages of the arthroscopic technique is also associated with the reduced morbidity and a short recovery period.

Download doc

Institution: Centro Hospitalar Tondela Viseu

Country: Portugal

E-mail: tiago.rebelo@gmail.com

Title: Klippel Feil Syndrome Diagnosis in Adulthood

Abstract: Introduction: Klippel-Feil Syndrome (KFS) is a rare genetic disorder, first described in 1912 by Maurice Klippel and Andre Feil. Its main feature is the fusion of two or more cervical vertebrae due to anomalies in segmentation between the 3 to 8 weeks of embryonic development. The KFS translates into complex visceral and bone changes including the classic triad of short neck, decreased neck movements and low-set hair. Material and Methods: We report the case of a patient of 49 years-old female, referred to outpatient orthopedics for chronic cervical pain with recent deterioration and irradiating to the left arm. There is a history of congenital deafness and mild mental retardation. We performed clinical history, physical examination and musculoskeletal imaging studies. Results Physical examination reveals the presence of the classic triad of KFS , short neck, little neck mobility and low-set hair . It is also possible to observe facial asymmetry. Imaging study showed spinal fusion C2 – C3 and C6-C7. Discussion KFS occurs in 1 of 42,000 births, approximately 60% of patients are female. There are described three types of KFS : Type I (40% ): complete cervical fusion ; Type II (45%) : fusion of 1 or 2 vertebral interspaces , usually C2 – C3 or C5-C6 ; Type III (12 %) cervical fusion and low thoracic or lumbar fusion . Other clinical changes KFS are dorsal kyphosis, facial asymmetry, deafness, lower line of the nipples, cardiac anomalies , Sprengel deficiency , respiratory disorders , gastrointestinal disorders , among others. Take Home Message The main feature in KFS is cervical spinal fusion. The diagnosis is clinical, usually carried out in childhood due to the typical physical characteristics.

Download doc

Institution: Ortopedska bolnišnica Valdoltra

Country: Slovenia

E-mail: benjamin.marjanovic@ob-valdoltra.si

Title: Latarjet 9 year follow up of 123 cases

Abstract: In our study group we used modified open ( Congruent – Arc ) technique in patients ( shoulders ), males and females average age of years for anterior glenohumeral instability between January and January. All shoulders had some osseous deficiency of the anterior glenoid rim or had at the same time reluxation after previous arthroscopic surgery. The results of all hundred – twenty – three shoulders were reviewed Six shoulders ( %) redislocated after repeated trauma due to epileptic seizures ( two ) or hypoglycemia ( two ) in one diabetic patient. Two patients had repeated sports trauma shoulders ( %) were subjectively graded as excellent or good. Dissatisfaction was associated with persistent subluxations ( %), persistent pain and inability to compete in sports at the pre – injury level. The mean Rowe score was ( range – ). The overall short – term complication rate was %. We divided complications into four groups intraoperative infection recurrent instability and neurologic injury Intraoperatively there was a fracture of the coracoid process during fixation in one shoulder ( %); additional resorbable anchors were used to stabilize coracoid fixation. A superficial ( above deltopectoral split ) infection developed in one shoulder ( %); the infection was successfully treated with debridement and antibiotics. Two shoulders ( %) developed recurrent glenohumeral subluxation these shoulders were treated with arthroscopic capsuloplasty and or remplissage. One procedure ( %) resulted in transient motor neurapraxia of musculocutaneous nerve which persisted for two months. Modified open Latarjet procedure is safe and effective surgical technique for restoring glenohumeral stability Indication for surgery should be limited in drug – resistant epilepsy or.

Download document

Institution: Centro Hospitalar de Vila Nova de Gaia Espinho

Country: Portugal

E-mail: tiagocpt@gmail.com

Title: Subscapularis arthroscopic repair

Abstract: Objectives: The aim of this work was to evaluate the results of arthroscopically treated patients with isolated subscapularis tendon tears. Patients and Methods: Ten patients with isolated tears of the subscapularis muscle tendon arthroscopically sutured between 2010 and 2014 were evaluated. Eight had traumatic lesions. Seven patients were male. The period of pre-operative symptoms ranged from three days to 72 months. Six had complete and four had partial tendon tears. There was 33,3% ofassociated lesions of the long head of the biceps tendon. Results: The mean range of motion of the patients has improved from preoperative to final evaluation from 120o to 145o of forward elevation, from 60o to 70o of lateral rotation and a medial rotation from T12 to T9. Six patients returned to their pre-injury level of sports activity. Using the UCLA score, 8 patients had excellent or good results. Conclusion: Surgically treated isolated tears of the subscapularis tendon lead to good results and patients satisfaction.

Download document

Institution: Burn and traumatology centre of Ben Arous

Country: Tunisia

E-mail: rafla22@hotmail.com

Title: Elbow dislocation with ipsilateral distal radius fracture

Abstract: Introduction : Fracture dislocations around the elbow joint are common and usually involve proximal radius or ulna. Posteromedial elbow dislocation with associated distal radius fracture is a rare entity. Only few cases of elbow dislocation with ipsilateral distal radius fracture have been reported in the literature. We report 04 cases of elbow dislocation with ipsilateral radius dislocation. Methods : We reported 04 cases of elbow dislocation associated to ipsilateral distal radius dislocation. The mea nage was 45 years. We reported 03 males and 01 woman. Results : In our serie, there were 03 postero lateral elbow dislocation and 01 posteromedial. The distal radius fracture were posteriorly displaced. All our patients had reduction with general anesthesia. The distal radius fracture was stabilized by pining. The limb was immobilized by supine cast. The patient judged the elbow motion satisfactory. Discussion : Elbow dislocation with ipsilateral distal radius fracture is a rare injury pattern. An extensive search of the literature showed that only few such cases with this combination are reported. The cases already reported are either compound fracture/dislocation or have occurred in children. This is the first serie of 04 patients reported in the littérature. Most probable mechanism to produce this type of injury would be a fall on the outstretched hand. First, the distal radius fracture occurred due to direct contact of wrist with the ground. This dorsal force would hyperextend the elbow causing dislocation. Conclusion : We recommend that in every case of elbow dislocation, wrist joints be assessed clinically as well as radiologically for any associated injury. A high index of suspicion of distal radius fracture should be kept in every patient of elbow dislocation.

Download document

Institution: Polytechnic of Zagreb

Country: Croatia

E-mail: pbonacic@tvz.hr

Title: Orthopedic Medical Software

Abstract: The rapid development of technology and collaboration and interaction of different occupations and professions just as the fact that we live in the information age, resulted in great progress in medicine. One of the technology is use of software for biomedical engineering.Today\’s medical systems, models and devices are controlled by this software that processing medical images and creating 3D models uses 2D cross sectional medical images such as from computed tomography (CT) and magnetic resonance imaging (MRI) to construct 3D models, which can then be directly linked to rapid prototyping, CAD, surgical simulation and advanced engineering analysis. The paper presents a summary structure of the software that are currently in use and their features and applications in orthopedics.

Download document

Institution: Centro Hospitalar de Vila Nova de Gaia Espinho

Country: Portugal

E-mail: ricardo.s.pereira@gmail.com

Title: Cephalomedullary nail breakage after trochanteric hip fractures

Abstract: Trochanteric fractures of the femur are common in elderly individuals with osteoporosis and usually require surgical treatment to facilitate early rehabilitation. Due to their inherent biomechanical advantage, the use of intramedullary nails is increasing, especially for the treatment of unstable trochanteric fractures. Mechanical breakage of cephalomedullary nail osteosynthesis is a rare but devastating complication usually attributed to delayed fracture union or nonunion. We present the cases of implant breakage in two female patients treated surgically for trochanteric fractures. After a period of good initial clinical recovery, both patients developed worsening hip and thigh pain and inability to bear weight a few months after the first surgery. In both cases, fatigue failure was observed at the junction of nail with the lag screw. One of the patients was treated with exchange nailing and autologous bone grafting and the other one with conversion to total hip arthroplasty using a modular, tapered, fluted stem. Both patients were able to partially recover their functionality and independence for the daily life activities with no pain. The results of this series demonstrate that both the described revision surgery options are able to provide good clinical and radiological short-term results in the rare cases of cephalomedullary nail breakage.

Download document

Institution: Centro Hospitalar de Vila Nova de Gaia Espinho

Country: Portugal

E-mail: miguelmcfrias@gmail.com

Title: Several surgical options are available on the treatment of proximal humeral fractures A secure reduction and fixation may be difficult to achieve The PHILOS plate has been developed with the aim of getting a better screw fixation on osteoporotic bone and minimize soft tissue dissection However postoperative complications still exist year old woman high energy car accident presents to the emergency department withafracture in parts of the proximal humeral with displacement of the posterior humeral head Was subjected to ORIF with plate PHILOS by a delto – pectoral approach At months postoperatively had a Constant Score of and imagiologically an internal rotation of the proximal humerus with respect to the humeral shaft Underwent further surgery at months post – fracture a liberation of the sub – scapular was performed with the troquino fragment removal of the distal screws and a surgical neck osteotomy with rotation of the distal fragment re – fixation and reinsertion of the troquino reinforced with transosseous sutures Passive mobilizations were initiated at days postoperative and active mobilization in the first month having a carefully targeted functional rehabilitation At – month follow – up after the second surgery had a Constant Score of and the osteotomy fully consolidated Despite the fastening system with PHILOS presents favorable results postsurgical complications including malunion and descoaptation of osteosynthesis material may happen In the literature this type of complication is described in approximately % of cases The medium Contant Score at months is described in the literature whereby the overlapping is observed in this case after the second surgery The fastening system with PHILOS is one of the available alternatives for fractures of the proximal humerus in most cases providing a stable fixation and early mobilization However although uncommon complications can occur namely malunion and the failure of the

Download document

Institution: KBC Zagreb

Country: Croatia

E-mail: katarina.barbaric@hotmail.com

Title: Radial head arthroplasty after previously performed resection of the radial head

Abstract: Radial head arthroplasty (RHA) is often used method in treatment of multifragmentar radial head fractures. Best results achives arthroplasty performed immediately after the fracture. In cases where radial head is irreparable, and there are no technical conditions for arthroplasty, resection of the radial head is available treatment option. With time, these patients develop different problems like: loss of strength, valgus instability and wrist pain due to proximal migration of the radius. Valgus deformity causes development of cubital tunnel syndrome. Elbow contracture occurs with time, manifesting in the form of a limited joint extension and flexion. Development of degenerative changes leads to the elbow pain appearance. In a one year period, in the Department of Orthopedic Surgery in University Hospital Centre Zagreb we performed RHA in 5 patients in whom radial head excision, due to fracture, was already done. There were 3 male and 2 female patients, average age 51.2 years (from 44 to 57). RHA in these patients was associated with several problems. One of the problems we encountered was inability to perform the arthroplasty due to previous excessive resection of radial head. An additional problems were abundant scar tissue that caused elbow contracture and increased risk of interosseus posterior nerve injury due to changed anatomical relations. Preliminary treatment results showed a significant improvement in the functional status accompanied by marked reduction in symptoms in average follow up period of 11.2 months (from 3 to 15). Although RHA is conceptually attractive and sound in situations in which radial head excision is inadequate, clinical experience is still limited. Surgical treatment requires precise preoperative planning, while in the postoperative period a persistent and long-term implementation of adequate physical therapy with mandatory prophylaxis of heterotopic ossification are required.

Download document

Institution: KBC Zagreb

Country: Croatia

E-mail: katarina.barbaric@hotmail.com

Title: Pedicled vascularized bone grafts for disorders of the carpus

Abstract: Pedicled vascularized distal radius bone grafts (VBG) offer a peculiar treatment option which can be used with other treatment procedures in the management of carpal disorders like: scaphoid nonunion, Preiser’s disease, or Kienböck’s disease.We present indications and different operative tehniques for four patients treated in our Department because of various carpal disorders. Two male patients with scaphoid nonunion were operated using different VBG. A 29-year old male with proximal pole nonunion was treated with capsular-based distal radius VBG. A 26-year old male, after failed Matti Russe procedure, was treated with distal radius VBG using 1,2-intracompartmental supraretinacular artery (1,2-ICSRA) and additional fixation with Herbert screw. The 1,2-ICSRA graft was also used for treatment Preiser’s disease in 33-year old women. Second stage of Kienböck’s disease in 29-year old female was treated with combination of distal radius shorthening osteotomy and revascularisation with 4,5 ICSRA VBG. In all operative procedures we used tourniquet but without exsanguination to facilitate identification of the vesels. The vascularity of the graft was confirmed during surgery with tourniquet release. Vascularized bone grafts have superior biological and mechanical properties resulting with faster and more reliably healing than nonvascularized grafts. They also bring osteogenic and angiogenic factors into site of avascular necrosis that facilitate revascularization and bone remodeling of the avascular segment or whole bone. VBGs therefore represent a unique option of biological reconstruction which can be used in a specific cases in order to preserve the integrity of the carpal bones and avoid salvage procedures, which are characterized by significantly poorer functional results, that can be extremely important in young, active patients.

Download document

Institution: KBC Zagreb

Country: Croatia

E-mail: katarina.barbaric@hotmail.com

Title: Reconstruction of distal ulna and distal radiolunar joint after wide resection of giant cell tumor

Abstract: A – year old man presented in our Department with pain in the distal part of his right forearm after fall and X – ray images that showed expansive formation in the distal part of the right ulna Detailed history revealed that he had pain in his arm months earlier Computed tomography magnetic resonance and bone scan followed by biopsy were preformed in our Department Uncertain patohistological findings could not distinguish if it was GCT or tumor had an osteosarcomal component so we decided for two stage procedure First we performed en bloc resection of distal cm of ulna and temporary reconstruction with cement spacer Triquetrum and pisiforme bone were also excised because imaging methods showed their involvement with tumor After definitive pathohistological confirmation of GCT gradus I – II second stage reconstruction procedure was performed Distal part of ulna was reconstructed with free autologous fibular graft fixed with mm DC plate and screws Distal radioulnar joint ( DRUJ ) was reconstructed with palmaris longus tendon with modified Adams procedure In order to compensate triquetrum and pisiforme bone loss and stabilize the ulnar side of the wrist interposition arthroplasty using half of the extensor carpi ulnaris tendon was done Ten months postoperatively patient was feeling well had no pain and had satisfactory wrist range of motion Control X – rays showed adequate integration of fibular graft at the site of osteosynthesis with no signs of tumor recurrence DRUJ was stabile and pain free DASH score during one year follow up improved to compared to preoperatively GCT of the distal ulna is rare tumor classified as benign aggressive but carry a relatively high rate of recurrence Although difficult to manage anatomical reconstruction after resection around wrist joint especially in young active patients should be method of choice when ever is possible.

Download document

Institution: SB Akromion

Country: Croatia

E-mail: starcevicdamir@hotmail.com

Title: Treatment of chronic transscaphoid perilunate dislocation of the wrist: A case report

Abstract: Introduction Transscaphoid perilunate dislocation of the wrist is complex injury that occurs from extensive, high-energy dorsiflexion. Early open reduction and internal fixation of these injuries is required to provide accurate alignment and the option for ligament repair. Chronic cases are very rare and can lead to permenant and devastating consequences. Their treatment represent great challange for surgeon. Methods A 19 year old man presented in our hospital with pain, swelling and limited ROM of the right wrist and tingling in first three fingers of right hand. Four months ago he was involved in car accident where he sustained fracture of his left collar bone, left forearm and right wrist. X-ray and CT showed dorsal transscaphoid perilunate dislocation, fracture of ulnar styloid, ulnar translocation of carpal bones and loss of carpal height. EMNG showed compression of median nerve in carpal tunnel. Decompression of median nerve in carpal canal was performed through volar approach. Dorsal approach through third extensor canal was used to expose carpus. A radially based, dorsal flap capsulotomy is performed, as it perserves dorsal ligamentous structures. Reduction of carpus and scaphoid was done and secured with Kirschner wires. Autologus canselous bone graft from distal radius was interduced in to the fracture site of scaphoid and fracture was fixed with FRS compression screw. We also performed fixation of ulnar styloid with transoseal suture. Kirschner wires were removed after 10 weeks and physical terapy started. Results Eighteen months after operation scaphoid fracture is healed, patient has no pain with satisfactory ROM and wrist function. Conclusion Systematic approach to this complex injury with anatomic reconstruction can result in favorable outcome and it should be attempted even after four months, especially in young patients.

Download document

Institution: Centro Hospitalar de Vila Nova de Gaia Espinho

Country: Portugal

E-mail: miguelmcfrias@gmail.com

Title: Longitudinal versus Transversal incision in the DeQuervain disease a comparative study

Abstract: The DeQuervain disease is a tenosynovitis of the first extensor compartment. Its surgical treatment was first described by Fritz de Quervain. The use of longitudinal or transverse incision has been described in many studies. The ideal incision should allow a good visualization of the radial aspect of the wrist and an easy extension in case of an unforeseen situation such as the presence of anatomical variations. The purpose of this study was to compare the clinical results of the use of longitudinal incision with transverse incision in the surgical treatment of DeQuervain disease. We retrospectively evaluated 88 patients (92 wrists) surgically treated to a DeQuervain tenosynovitis from March 2005 to March 2013. Most of the patients were female and the mean age was 55.7 years with a mean follow-up of approximately 7 years. The right wrist was operated in most cases. A longitudinal incision was used in 58% of the cases and a transverse incision in the remaining. The total percentage of complications was 9%, with 43% of cases affecting patients with longitudinal incision and 57% patients with transverse incision. This difference was not statistically significant. The most common complications were the development of painful neuroma, palmar subluxation and paresthesias in the territory of the sensory branch of the radial nerve. Of patients with complications, 50% required surgical reintervention. The average QuickDash score was 27.3 in patients with longitudinal incision and 28.4 in patients with transverse incision. There was no statistically significant difference between the two scores. In the presented series there were no statistically significant differences between the two incisions with respect to post-operative complications and scores.

Download document

Institution: Ortopedska bolnišnica Valdoltra

Country: Slovenia

E-mail: nejc.kurincic@ob-valdoltra.si

Title: The algorithm for shoulder arthroplasty implant selection

Abstract: The algorithm for shoulder arhroplasty implant selection Nejc Kurinčič, Rihard Trebše Valdoltra Orthopaedic Hospital, Ankaran, Slovenia Introduction There still is no consensus in the literature regarding indications for a particular type of implant in primary shoulder arthroplasty. Objectives Algorithm for shoulder implant selection was introduced in 2000. Our aim was to choose the least invasive procedure for a particular situation and to avoid late complications: 1. Healthy patients up to 60 years old independently of the diagnosis: hemiarthroplasty, either stemmed or resurfacing, 2. Old patients primary arthrosis: total shoulder arthroplasty. In inflammatory arthritis and conditions that limited life expectancy or activity this indication was extended to younger patients, 3. Old patients cuff arthropaty and acceptable function: hemiarthroplasty, stemmed or resurfacing, 4. Old patients poor function – pseudoparalysis – inverse shoulder arthroplasty. Methods 183 shoulders were operated according to the protocol. The surgical approach was standardized deltopectoral. All patients had returned for at least 1 follow up visit (mean 5 years, range 1-13 years). Results The CM score improved considerably from 24 points preoperatively to 74 at the last follow-up. There were no definite nerve lesions, and nobody suffered a major adverse event during hospitalisation. There were three revisions – 1,6% (early infection with Staphylococcus conii, posttraumatic dislocation and persistent pain). Conclusions The algorithm proved to effectively select patients for appropriate implant giving high satisfaction rate and low revision burden. Keywords: Shoulder, Arthroplasty, Primary, Algorithm.

Download document

Institution: KBC “Sestre milosrdnice”

Country: Croatia

E-mail: cengict@me.com

Title: Intraoperative gamma hand ‐ held probe navigation in resection of osteoid osteoma tumor – report of two cases

Abstract: Introduction We would like to present two cases with osteoid osteoma tumor (OO), and report our early experience of intraoperatve gamma probing to localize OO at surgery. The concept of radioguided surgery was developed 60 years ago and the application of gamma detection probe technology for radioguided biopsy and/or resection of bone lesions dated from the early 80s. Bone scintigraphy is very important for initial diagnosis of OO with almost 100% sensitivity. The bone scan finding is specific – so called double density appearance; very intense accumulation of radiopharmaceutical in nidus and therefore great difference between the nidus and surrounding healthy bone, which made possible to treat this lesion with probe guided surgery. Method Three phase bone scintigraphy and SPECT (single photon emission computed tomography) was conducted in our patients for initial diagnosis of OO. A second bone scintigraphy was performed before surgery. The surgery followed 12 – 15 hours later by intraoperative nidus detection with hand-held gamma probe. Gamma hand-held probe is system that detects gamma photons. The count rate in the nidus area at the day of surgery was 3 to 4 times higher than the healthy bone area. The drilling was performed until the counts decreased to the level of the counts of surrounding bone, thereby confirming complete excision. Take home message This is the method of choice because of minimizing bone resection, the risk of pathological fracture, need for bone grafting and because of shortening the period of reconvalescence. Evidence of the treatment efficiency is the pain disappearance after surgery.

Download document

Institution: Ortopedska bolnišnica Valdoltra

Country: Slovenia

E-mail: matevz.topolovec@ob-valdoltra.si

Title: The use of vacuum in reinfusion drain systems can increase postoperative blood loss after total hip replacement surgery

Abstract: In elective surgery, such as knee and hip arthroplasty, most orthopedic surgeons routinely insert drains for draining wounds. Now days, postoperative autologous blood reinfusion systems represent an alternative to homologous, banked blood transfusions. The purpose of our prospective study was to determine the role of vacuum in reinfusion drain systems in hip arthroplasty patients. In both groups we used reinfusion drainage system Ortho PAS. In one group we used a vacuum (40 cm H2O), in the other group we did not use any vacuum. We found that the use of vacuum drainage significantly affect the amount of blood loss during the first 4 hours in total hip arthroplasty.

Download document

Institution: 424 Military general hospital-Thessaloniki

Country: Greece

E-mail: evi_dim45@hotmail.com

Title: Dorsal closing wedge calcaneal osteotomy for the treatment of insertional achilles pathology. 5 years follow up.

Abstract: Purpose: Aim of this study is to prospectively evaluate the efficancy of the dorsal closing wedge calcaneal osteotomy in athletes with chronic insertional Achilles pathology after failure of the conservative management. Methods: Between 2007-2010, 64 dorsal wedge calcaneal osteotomies were performed in 52 athletes diagnosed with insertional Achilles pathology treated conservatively but unsuccessfully for 6 months. A lateral approach was used and the osteotomy was fixed with 2 staples.AOFAS and VISA-A scores were used preop and 1year postop. Results: Average age was 35y (range 19-52y). All patients were followed-up for a mean 5 years. AOFAS score was improved from 58points preop to 92points postop (p<0.05) and the VISA-A score from 67p to 94p (p<0.05). Clinical results were considered as excellent in 83% of the cases, good in 14% and fair in 3%. Complications included wound problems (5), recurrent retrocalcaneal bursitis (2) and nonunion of the osteotomy in one case which treated with bone grafting and revision of fixation. Conclusion: Dorsal wedge calcaneal osteotomy is a safe and efficient method for the treatment of chronic insertional Achilles tendinopathy after failure of conservative management in athlettes. It is dramatically improves symptoms and allows athletes to return to their previous sport activities.

Download document

Institution: 424 Military general hospital-Thessaloniki

Country: Greece

E-mail: evi_dim45@hotmail.com

Title: Treatment of osteochondral lesions of talus with osteochondral transplantation of autologous graft. 5 year follow up.

Abstract: PURPOSE: Bone marrow stimulation procedures (microfractures/drilling) are considered the gold standard for the primary treatment of osteochondral talar lesions. In the literature, there is lack of evidence about the appropriate treatment in cases of failure of these procedures. A technique of osteochondral autologous transplantation of talar graft was used. It was hypothesized that this is a successful method with good results and low complication rates. METHODS: Between 2004 and 2007, 46 patients (37 males, 9 females), with OLT for which arthroscopic treatment with curettage and drilling or microfracture had failed, underwent osteochondral transplantation with an osteochondral graft harvested from the ipsilateral talar articular facet. A medial malleolar osteotomy or a distal tibial wedge osteotomy was used to access the talar dome defect. RESULTS: The median follow-up time was 5.5 years (range 52-75 m). 34 lesions were located in the central talar dome in the coronal plane, while 26 and 19 lesions were located in the lateral and medial aspect of talar dome in saggital plane, respectively. The overall improvement between the preoperative and post-operative AOFAS and VAS FA score was 35 points (p < 0.001) and 39 points (p < 0.001), respectively. Clinical results were considered as good in 43 patients (93.4 %) and fair in three patients (6.5 %). No complications occurred at the site of the malleolus osteotomy or tibial osteotomy and the donor site at the talus. CONCLUSIONS: The midterm results suggest that the technique of osteochondral transplantation of autologous talar graft for osteochondral lesions of talus after failure of primary treatment with bone marrow stimulation can be safely and successfully used. It demonstrates excellent post-operative scores including improvement of pain and function and does not yield complications experienced with other procedures.

Download document

Institution: 424 Military general hospital-Thessaloniki

Country: Greece

E-mail: evi_dim45@hotmail.com

Title: Proximal opening wedge metatarsal osteotomy for the treatment of moderate to severe hallux valgus deformity.

Abstract: PURPOSE: Hallux valgus is a complex deformity of the first metatarsophalangeal joint, with varus angulation of the first metatarsal, valgus deviation of the great toe and lateral displacement of the sesamoids and the extensor tendons. The aim of the surgery is to achieve correction of the varus deviation of the 1st metatarsal which is considered by some as the primary intrinsic predisposing factor to hallux valgus deformity. METHODS: We retrospectively reviewed 85 patients (107 feet) who underwent an opening wedge osteotomy of the 1st metatarsal for correction of moderate to severe hallux valgus and metatarsus primus varus. A medially applied anatomic pre-contoured locking plate was used for fixation of the osteotomy. RESULTS: The mean IMA was decreased from 15.8 (range 12-22) degrees to 7.8 (range 0-12) degrees. The mean pre-operative HVA was 39 (range 21-52) degrees and the mean postoperative HVA was 11.8 (6-19) degrees. The pre-operative AOFAS score was 52 (SD 3.1) and the postoperative score was 85 (SD 5.2). CONCLUSION: The proximal opening wedge metatarsal osteotomy is a safe, effective and reproducible technique for correction of moderate to severe hallux valgus deformity. The use of a locking plate provides enough control at the fragments, enhancing healing of osteotomy and maintenance of the correction even with a violated proximal lateral cortex

Download document

Institution: 424 Military general hospital-Thessaloniki

Country: Greece

E-mail: evi_dim45@hotmail.com

Title: Dysfunctional 1st MTP joint fusion converted to interposition arthroplasty in relatively young unsatisfied patients. 3 years follow up

Abstract: Aim: Arthrodesis of the 1st MTP joint for the treatment of osteoarthritis is a safe method with low complication rate. Patient unsatisfaction with mobility difficulties is rare complication difficult to treat. The aim of this study is to evaluate the conversion of dysfunctional 1st MTP joint fusion to interposition arthroplasty and to report our results in 6 cases with 3 years follow up. Methods: 6 patients who were unsatisfied and complaining of mobility difficulties after 1st MTP joint fusion for OA, were treated surgically with conversion of the fusion to interposition arthroplasty. Fascia latta allograft was used and interposed in the excised 1st MTP joint space. Results: At a minimum follow up of 3 years the patients’ AOFAS score was improved at a mean of 24 (13-38) points due to improvement of function and pain. Satisfied with the outcome and were willing to consider the procedure again. The mean postoperative ROM before subluxation of the allograft was 63° of dorsiflexion and 21° of plantarflexion which was considered excellent by all patients. No complications were encountered. Discussion: Converting dysfunctional 1st MTP joint fusion to interposition arthroplasty could be considered a safe alternative solution with promising results in selected cases especially in relatively young population.

Download document

Institution: Centro Hospitalar Tondela Viseu

Country: Portugal

E-mail: zicogoncalves@gmail.com

Title: Neuropathic Arthropathy of the Knee secondary to Familial Amyloid Polyneuropathy

Abstract: Arthrodesis is a fallback option to obtain a stable and painless knee when joint damage is not subject to reconstruction. The main indications for knee arthrodesis are arthroplasty failure, malignancy, post-traumatic osteoarthritis, irreparable injury to the extensor apparatus, chronic infection and neuropathic arthropathy. This work aims to show the clinical case of a patient with Familial Amyloid Polyneuropathy, which started unilateral knee pain with progressive worsening and with in less than a year of evolution, culminated in knee arthrodesis. A 47 years-old female, with Familial Amyloid Polyneuropathy, obese, hypertensive, transplanted liver and under immunosuppression, referred for outpatient orthopedics for left knee pain of sudden onset and not associated with trauma. Imaging study conducted and therapeutic procedures as viscosupplementation and arthroscopy. Having regard to unfavorable clinical course was held arthrodesis with a locked, long intramedulary nail, entering in the piriformis fossa with autologous bone graft. Arthrodesis of the left knee in 10º of valgus and 15º of flexum with good clinical evolution and radiological signs of progress toward fusion, walking with support of crutches. Diffuse pain complaints, without neurovascular or soft tissue injury. Gradually resumed activities of daily living. Faced with a patient with neuropathic arthropathy of the knee secondary to Familial Amyloid Polyneuropathy, highly disabling and with such fast evolution, this option allowed the definitive treatment in a single surgical procedure without complications. This option for arthrodesis allows better mobility in the postoperative period (without external mechanisms), early loading and a success rate that is up to 95% The treatment options for a neuropathic neuropathy are reduction of activities, orthoses and in advanced cases immobilization with arthrodesis, arthroplasty is contraindicated. With this method, the treatment was possible in a single surgical procedure without complications and gradual return to activities of daily living.

Download document

Institution: Centro Hospitalar Tondela Viseu

Country: Portugal

E-mail: zicogoncalves@gmail.com

Title: Ellis Van Creveld Syndrome Bilateral Genu Valgus Correction

Abstract: Ellis Van Creveld syndrome ( EVCS ) or chondroectodermal dysplasia is an autosomal recessive disease extremely rare and that results from mutation of EVC and EVC2 genes It is characterized by cardiac malformations polydactyly ectodermal dysplasia and chondrodysplasia of long bones We present a case of bilateral genu valgum EVCS surgically corrected with femur and tibia osteotomies Material We present the case of a year – old caucasian female referred to the outpatient by persistent bilateral knee pain and lower limb deformity which conditioned gait limitation At physical examination she has low height ( cm ), chest tightening bradidactilia tooth and nail hypoplasia alopecia and bilateral genu valgus History of cardiac surgery ( congenital heart disease – atrioventricular communication ) and correction of polydactyly C Methods The patient underwent correction of bilateral genu valgum the left in May and the right in December The procedure was a distal femur Coventry osteotomy and tibial external addition with bone autograft D Results – Good clinical course without knee pain improved gait pattern standardization of functional mechanical axis of the lower limbs osteotomy consolidation and patient satisfaction E Discussion – The diagnosis of EVCS is essentially clinical From an orthopedic point of view it is necessary to correct the genu valgum condition because it leads to early osteoarthritis The combined osteotomies ( tibiofemoral ) are indicated for severe deformities in which the simple proximal or distal osteotomy to the joint would be insufficient Genu valgum is commont in children ( physiological ). However in some cases such as EVCS the deformity correction ie needed Among the different options osteotomies are probably the most common method for correction of angular deformities In this case a high level of satisfaction was achieved both aesthetically and clinically and an

Download document

Institution: Centro Hospitalar Tondela Viseu

Country: Portugal

E-mail: joaomorenomorais@gmail.com

Title: ACL revision surgery Case report

Abstract: Introduction: The reconstruction of the anterior cruciate ligament (ACL) is a common procedure held by most orthopedic surgeons. This procedure provides high success rates. However, despite the development of surgical techniques, failure rates are shown ranging from 3 to 15%, according to the literature. Failures occur most often due to technical errors, and may also be associated with repetitive injuries, concomitant injuries, among other causes. Material: We present the case of a 38 years old patient, with a total rupture of right ACL in 2006, and at the time was reconstructed with bone-tendon-bone technique. Referred to outpatient orthopedics by instability and pain at the right knee, with positive Lachman test. The patient was operated in February 2013. It was observed by arthroscopy: ligament rupture, femoral tunnel with too posterior position and fracture of the internal meniscus. Carried out ACL repair with hamstrings tendons and internal partial meniscectomy. Results: The patient fulfilled rehabilitation program in the postoperative period, subject to a month and a half after surgery, walks without support, claudication, joint effusion, instability or changes to the active and passive mobilization of the knee. Discussion: Of all the possible causes of failure, technical errors are the most common, accounting for 77% to 95% of cases of ACL ligament failure. The most common error with respect to the non-anatomical positioning of the tunnels, being the position of the origin of the femoral tunnel in most cases. The femoral tunnel is positioned too anterior often resulting in loosing of the graft in flexion and extension. Conclusion: ACL ligament review is a challenge for the surgeon, is associated with worse outcomes than primary reconstruction. Performing a ACL ligament revision requires a preoperative planning to identify the cause of failure and avoid repeating the same mistakes in revision surgery.

Download document

Institution: Centro Hospitalar Tondela Viseu

Country: Portugal

E-mail: tiago.rebelo@gmail.com

Title: Ankle Pigmented Villonodular Synovitis Arthroscopic Ressection

Abstract: Introduction: Pigmented villonodular synovitis (PVNS) is a rare proliferative disorder of the synovium, which affects young and middle-aged adults. This condition may be locally destructive and involve the muscles, tendons, bursa, skin and bones. The incidence of SNVP in the ankle joint is approximately 2.5%. Patients are frequently presented with pain, swelling and joint effusion. Material and Methods: Female patient 45 years old with pain, swelling and joint effusion of the right ankle with 4 weeks of development unrelated to trauma. Underwent ankle arthroscopy, which verified the presence of synovial lesion and an osteochondral lesion of the talus. Excision of synovial injury was done and the injured cartilage of the talus removed and microfractures were performed. Results: The patient started full weight bearing at 8 weeks after arthroscopy without new episodes of pain or hemarthrosis. Presents total ankle mobility, having resumed work without restrictions. At last follow-up visit 1 year after diagnosis and treatment, has no imaging evidence of local recurrence. Discussion Magnetic resonance imaging is a useful non-invasive means of diagnosis based on hypodense, diffuse infiltrative lesion involving soft tissue structures in T1 and T2. The ideal treatment of PVNS is surgical excision. A complete synovectomy is the preferred treatment for PVNS. The incomplete removal likely results in recurrence of the lesion. Its recurrence rate is up to 46%. Moderate dose external radiotherapy can improve the probability of local control in recurrence cases. Take Home Message A combination of clinical, radiological and histological correlation is needed for the diagnosis of PVNS. Treatment consists of complete synovectomy and the recurrence rates are high.

Download document

Institution: KBC “Sestre milosrdnice”

Country: Croatia

E-mail: tadijap@icloud.com

Title: Overuse syndrome of foot in school aged children and the use of orthopaedic insoles

Abstract: We analyzed the use of orthopedic insoles based on a sample of 250 school-aged children (age 7-16 years) due to foot pain induced by sports and other physical activities. Most patients (84%) complained of pain due to sports activities. Pain was most frequently associated with basketball (34.7%) and least frequently with volleyball and martial arts (2.4%). Most children used orthopedic insoles whole day (58%). The mean level of pain at the first examination was 4.4+1.37. At the control examination 82% of patients reported having no pain, while in the remaining 18% of patients the level of pain reduced to 1.7+0.87. Most children rated their orthopedic insoles with “very satisfied”, while the lowest rating they gave in their evaluation was “neutral”. The use of orthopedic insoles is extremely important in treatment of foot pain, whether it was induced by flexible flat feet, overuse foot syndrome and/or some other conditions.

Download document

Institution: KBC Osijek

Country: Croatia

E-mail: vjekoslav.wertheimer@gmail.com

Title: Knee stability after arthroscopic anterior cruciate ligament reconstruction using the middle third of the patellar ligament and quadrupled hamstring tendons grafts a two year follow up

Abstract: Knee stability after surgical anterior cruciate ligament (ACL) reconstruction using quadrupled hamstring tendons graft (gracilis and semitendinosus) and the middle third of the patellar ligament was compared. All subjects participating in this study had ACL rupture diagnosed by clinical examination and MRI and underwent identical surgical procedure apart from the choice of graft. Total of 112 patients with either patellar ligament or quadrupled hamstring tendons graft were evaluated during 24 months after the surgery. Patients were similar according to age, sex, activity level, knee instability level and rehabilitation programme. Clinical tests and a measuring instrument KT-1000 arthrometer were used to evaluate the knee stability after the reconstruction. During the 24-month study there were no significant differences in clinical stability of the knee and the use of both grafts resulted in satisfactory knee stability. The difference between the groups according to the graft was noticed 6 months after the reconstruction when the results obtained by a measuring instrument showed that knee stability was significantly higher in patellar ligament graft (Fisher’s exact test).

Download document

Institution: Sv. Katarina

Country: Croatia

E-mail: eduardrod1508@gmail.com

Title: Autologous spongioplasty and cell free scaffold assisted femur lateral condyle stage IV avascular necrosis repair

Abstract: Background and purpose: The subchondral bone and the calcified cartilage are continuous and are crucial supportive structures involved in load transmission. Understanding of interactions between articular cartilage and subchondral bone continues to evolve. Treatment options for stage IV avascular necrosis of femoral condyle depend on the extent and location of the osteonecrotic area, patient age, and level of activity. One of the surgery options for such advanced cases is bone grafting and one step call free scaffold assisted cartilage repair. Materials end methods: A 35-year-old female patient underwent arthroscopic surgery of the knee for a stage IV AVN of the lateral femoral condyle. Clinical outcome scores and knee MR were recorded pre-operatively, after 6 weeks and after 6, 10 months postoperatively. At 3 months after implantation of a cell-free type I collagen matrix, the patient was again treated arthroscopically for a contracture of same knee. After diagnostic arthroscopy the cell-free scaffold size 25x20x6 mm (CaReS-1S®, Arthro-Kinetics, Austria) was implanted according to the manufacturer\’s recommendation. The underlying subchondral bones defect was prepared and fulfilled with autologous spongioplasty. The postoperative rehabilitation program was carried out according to a standard protocol. Results and conclusion: The patient is satisfied with the results of the operation and is able to carry out everyday activities The clinical results were favourable and an improvement in function and a decrease in pain were evident from preoperative values. On knee MR 10 mounts postoperatively the previous chondral defect showed good implant integration, no dislocation and just mild signs of inflammation. One step cells free scaffold based procedures for cartilage repair simplify and further improve regenerative techniques. The resorbable scaffold builds up a nature 3D environment which optimises cell migration and ingrowths.

Download document

Institution: Service of Orthopaedy and Trauma. Regional Hospital Durres

Country: Albania

E-mail: nmyderrizi@yahoo.com

Title: Proximal Femoral Nailing vs Dynamic Hip Screw in Intertrochanteric Fracture in elderly people.

Abstract: Background: The aim of this study was to compare the results of proximal femoral nail (PFN) and dynamic hip screw (DHS) in treatment of intertrochanteric fractures. Material/Methods: 63 patients were treated by a dynamic hip screw and proximal femoral nail in Service of Trauma in Regional Hospital Durres during 2012-2014. Fractures were classified under AO. Patients were operated under X ray intensifier control. Functional outcome, duration of operation, blood loss, rate of union, amount of collapse were studied and statistically evaluated for both of groups. Results: The average age of our patient is 77.3 (57-95) years. 15/48 male/female. Fractures were classified under AO, 23.8% A1, 58.7% A2 dhe 17.5% A3. The average operating time for the patients treated with PFN was 49.3 min as compared to 72.3 min in patients treated with DHS. The average of intraoperatory blood loss was 85.4 and 122.2 ml in PFN and DHS group, respectively The patients treated with PFN had better Harris Hip Score in the early period (at 1 and 3 months) and earlier ambulation, but in the long term (at 6 and 12 months) both the implants had the same functional outcomes. Conclusions: The current evidence indicates that PFN may be a better choice than DHS in the treatment of intertrochanteric fractures.

Download document

Institution: Burn and traumatology centre of Ben Arous

Country: Tunisia

E-mail: rafla22@hotmail.com

Title: Solitary exostosis of the foot and ankle

Abstract: Purpose: Osteochondroma represents the most common benign bone tumor and occurs most frequently in the proximal humerus, tibia, and distal femur. The bones of the foot and ankle , by comparison, are less commonly involved. We tried to describe the epidemiological, clinical particularities of this tumor and Its prognosis. Methods: A retrospective study of 11 patients( 06 males and 05 females, mean age 23 years 15to 38 years) . There are 07 osteochondroma in the ankle ( 04 in tha fibula and 03 th tibia). 04 ostochondroma of the foot: 02 in the metatarsal, 01 the third toe and 01 in the calcaneus. Results : The diagnosis delay was 05 years(04 months to 18 years). The mean diameter in the ankle was 2.8 cm and in the foot was 1.5 cm. we reported 05cases of traumatisme. The X rays were usual in 09 cases. All our patients had surgical removal of the osteochondroma.and histological study. No case of recurrence was repoted. . Conclusion: Surely we present a hetrogeneous study, we tried to make a profile of this rare localisation of the osteochondroma in order to better deal with this entity.

Download document

Institution: Burn and traumatology centre of Ben Arous

Country: Tunisia

E-mail: rafla22@hotmail.com

Title: Ewing’s sarcoma of the foot and ankle: limb salvation Vs limb amputation

Abstract: Purpose: Ewing’s sarcoma (ES) of the foot and ankle is a rare condition whose treatment is controversial. There are no large series covering this issue. Some authors advise amputation as the “gold standard” treatment. We report 04 cases of Ewing sarcoma. The authors report 03 cases of amputation and 01 case of limb salvation. Methods: Our study is about 04 cases: 02 occurs in the fibula, 01 in the third metatarsal and 01 in the navicular. The mean age was 22 years ( 18 to 28 years) 02 females and 02 males. The mean delay was 10 years(06 to 12years). Results: The mean diagnosis delay was 01 year(06 months to 14 months). The diameter was 04to 05 cm in the ankle and 03to 05 cm in the foot. All the patients presented pain and swelling. All the patients had Xrays, CTscan and MRI. They have shown images that helped the diagnosis. All the patients had biopsies that confirmed the diagnosis. In all the cases, the patients had preoperative chemotherapy. 03 patients ( 01 with the ankle localization and 02 in the foot) had amputation. In 01 case we opoted for surgical extirpation of the tumor and tibiotalar arthrodesis. We don’t report any case of recurrence. Conclusion: Chemotherapy and resection with reconstruction of the foot yielded excellent results in ES cases. Survivorship of ES in distal locations seems to be better than for proximal ones. Even in many cases amputation is a solution. We can try to save the limb as often as possible.

Download document

Institution: Burn and traumatology centre of Ben Arous

Country: Tunisia

E-mail: rafla22@hotmail.com

Title: Juxta-cortical chondroma of the foot and ankle

Abstract: Purpose : Juxta-cortical chondroma is a benign, slow-growing cartilaginous tumor that typically occurs at the metaphysis of long tubular bones beneath the periosteal membrane. It is a rare localisation in the foot and ankle. By this work, we tried to study the characteristics of the juxatacortical chondroma. Methods: We report 03 cases of juxtacortical chondroma, 02 occuring in the foot and 01 case in the distal tibia. The mean age was 20 years(15to 27 years). 02 males and 01 female. Results : The size of the chondroma in the foot was between 1.5 and 03 cm, in the ankle it was 05 cm. There were no history of traumatisme. All the patients were operated and have surgical removal of the tumor. A histoligical study was performed confirming the diagnosis of periosteal chondroma. With a delay of 07 years, there were no recurrence. Conclusion: Periosteal chondroma represents a distinctive benign cartilage tumor, apparently originating in the periosteum. It is a rare lesion , particularry in the foot and the ankle. The treatment is a surgical extirpation and an anapathological study.

Download document

Institution: OB Varaždin

Country: Croatia

E-mail: marko.labas@gmail.com

Title: Arthroscopic Meniscus Repair

Abstract: Injuries of the meniscus are one of the most common injuries in knee joint. Development of arthroscopic technique and also better understanding of ostheoarthritis mechanisms have shown the important role of meniscus in prevention of secondary ostheoarthritis. Meniscus is a connective – cartilagenous tissue. In cross – section it is wedge – shaped. It is divided in three zones red zone is vascularized zone, red – white zone is the transitional one and white zone is the inner avascular part of meniscus which gets its nurture by diffusion. Meniscal laesion is a result of trauma or degeneration. It can be isolated or combined with other injuries of the knee joint ( e. g .ACL rupture ). Indications for meniscus suturing are age ( < 40 ), time elapsed from injury (< 3months ), laesion characteristics ( longitudinal laesion in red or red – white zone “ bucket handle tear ”) and also associated injuries ( ACL rupture ). There are three basic suturing techniques, outside – in, inside – out and all-inside. For successful repair fine surgical technique and knowledge of all three techniques is required. In Department of Orthopaedics and Traumatology at The General Hospital Varazdin from March to April there were 248 arthroscopic procedures of the knee. In 15 patients were performed arthroscopic meniscal repairs by suturing (14 male, 1 female patient). Thirteen of these were medial meniscus laesions, two were lateral meniscus laesions Also five of these cases were associated injuries of ACL and thus ACL reconstruction and meniscus suturing were done at the same time. Outside–in and all–inside ( OMNISPAN ) techniques were used. On average, patients were monitored for six months afterwards. As a complication we had four rerupture. Two of them with rerupture of lateral meniscus and two with medial meniscus rerupture

Download document

Institution: Klinika za dječje bolesti Zagreb

Country: Croatia

E-mail: marijana.simic81@gmail.com

Title: Our experiences with knee tumor megaendoprosthesis and total femur reconstructions

Abstract: INTRODUCTION: Functional reconstruction following large tumor resections are challenging especially in growing children and require experienced orthopedic surgeon. The aim of this work is to show our experiences with large metal allografts replacing lower extremity long bones in pediatric and adult patients. MATERIALS AND METHODS: In period between 2009 and 2015 we operated 11 patients with malignant bone tumors, aged from 9 to 68. Seven of them were younger than 25. In 4 cases the bone deficit was made up by total femur and knee tumor endoprosthesis (Johnson&Johnson or Stryker), and in 7 cases by knee tumor megaendoprosthesis . RESULTS: Pediatric patients had leg length discrepancy 3 to 9 centimeters. Two patients underwent reoperation because of trauma caused periprosthetic fracture, which occurred about 5 years after primary reconstruction. One patient still has Proteus caused infection problem and one died two years later as a consequence of a tumor disease. DISCUSSION: Tumor knee alloarthroplasty and total femur replacement are good reconstructive solutions in limb salvage procedures, especially in conditions of human bone allograft deficit although are burdened with complications such as infections, bone fractures and implant breakage. Mechanical complications occur more frequently in active children and young adults, representing additional problem to solve.

Download document

Institution: Centro Hospitalar de Vila Nova de Gaia Espinho

Country: Portugal

E-mail: miguelmcfrias@gmail.com

Title: Tibial plateau fractures – Epidemiology and its surgical management in a Grade I Trauma Center

Abstract: The tibial plateau fractures account for 2% of all fractures, with this percentage increasing in the elderly population. Epidemiological studies are essential tools for understanding their occurrence. The most widely used classification was introduced by Schatzker and divides it into 6 types. Its primary treatment is crucial in the prevention of late complications. Each fracture pattern leads to different types of surgical treatment. In this study 92 cases of tibial plateau fractures surgically treated in a grade I trauma center were retrospectively analyzed from January 2009 to December 2013. Were taken into account the gender, age, type of trauma and associated injuries, fractures classification, type of surgical used and its complications. Functional assessment was evaluated according to the Knee Society Score. We analyzed 34 women and 58 men with an average age of 49 years, being the leading cause of injury road traffic accidents with the left knee being the most affected. The most and the least type of fracture seen were respectively types II and IV. Open reduction and internal fixation with plate, screws and graft placement was the most used. Complications were recorded in 4% of patients, and 2 of them required a total knee arthroplasty. Functionally, 84% had good to excellent results, and the vast majority returned to daily and sport activities prior to the occurrence of the injury. As the knee is one of the main load-bearing joint, timely and appropriate surgical treatment of fractures of the tibial plateau plays a key role in the restoration of the articular surface and prevention of late complications, preventing the progression to post-traumatic arthrosis and promoting reestablishment of a normal joint function.

Download document

Institution: Centro Hospitalar de Vila Nova de Gaia Espinho

Country: Portugal

E-mail: ricardo.s.pereira@gmail.com

Title: Endoscopic Calcaneoplasty in the treatment of Haglund’s disease

Abstract: Haglund’s disease, also referred to as “pumpbump,” is defined as the complex of symptoms involving the presence of an enlarged posterosuperior border of the calcaneus, retrocalcaneal bursitis, and superficial Achilles tendon bursitis. After failure of the conservative treatment, operative treatment – surgical bursectomy and resection of the calcaneal exostosis – is indicated by many authors. Open surgical procedures are effective but a relatively high incidence of complications has been described – skin breakdown, painful or non-cosmetic scars, infection, avulsion of the Achilles tendon, or persistent pain due to inadequate bone resection. Recently, several authors have reported good results and less morbidity with an endoscopic technique through posterior portals for the treatment of patients with a calcaneal exostosis. We aim to present our technique and results with endoscopic calcaneoplasty in 8 patients (9 ankles). Follow-up ranged from 5 to 18 months (mean 10.2). All patients showed clinical improvement – There were two good and seven excellent results measured by the Ogilvie-Harris score and the mean preoperative AOFAS score improved from 52.6 in the pre-operative period to 88.2 at final follow-up. One patient complained of paresthesias in the sural nerve territory that spontaneously resolved by the first post-operative month. There were no other intra- or postoperative complications. Even though further comparative studies are necessary, endoscopic calcaneoplasty appears to be a good alternative to open resection for the treatment of Haglund’s disease. It is safe, minimally invasive and allows a fast functional recovery.

Download document

Institution: SB Akromion

Country: Croatia

E-mail: starcevicdamir@hotmail.com

Title: Modified inside-out to all in meniscus repair technique for treatment of longitudinal tear of lateral meniscus in popliteal hiatus: a case report for treatment of longitudinal tear of lateral meniscus in popliteal hiatus_ a case report

Abstract: Introduction It is well known that injury of lateral meniscus significantly alters the load transmission pattern across the knee, resulting in higher contact stresses, decreased contact area, and an increase in the contact pressure and shear forces across the articular surfaces. All that changes can lead to accelerated cartilage wear and osteoarthritic changes. Lateral meniscus tears in area of popliteal hiatus are not suitable for repair with inside-out and outside-in technique, because sutures cannot be placed onto joint capsule or on to popliteal tendon. For that reason we modified inside-out technique. Aim The aim of this study is to present modified technique for repair of longitudinal tear of lateral meniscus in popliteal hiatus. Methods Eighteen year old male football player underwent arthroscopic repair for isolated lateral meniscus tear. We used modular cannula to reach desired place on lateral meniscus in region of popliteal hiatus. Two long needles loaded with nonabsorbable suture were pushed through cannula, meniscus, beside popliteal tendon, and through joint capsule and skin. Both suture ends were found between meniscus and capsule, and brought back in to that joint and pulled out of the joint through anterolateral arthroscopic portal. Suture was secured inside of the joint, behind the base of meniscus with sliding arthroscopic knot, using the knot pusher, thus leaving lateral meniscus mobile. Results After arthroscopic repair patient worn adjustable knee brace for 6 weeks with full weight bearing. Postoperative Lysholm score was 95 after postoperative rehabilitation, Tegner activity score was 7, same as before operation, and patient returned to playing football. Conclusion Rapid deterioration of the lateral compartment after meniscal injury and/or meniscectomy suggest that repair of lateral meniscus should be done whenever possible. This technique is effective and economic procedure that can help us preserve important function of lateral meniscus.

Download document

Institution: Institute of Orthopedics, physical medicine and rehabilitation Dr. Miroslav Zotović

Country: BiH

E-mail: pcvijic@gmail.com

Title: Transexamic acid in hip and knee arthroplasty our experiences

Abstract: Introduction: Tranexamic acid is the antifibrinolytic agent. Its antifibrinolytic effect is achieved by blocking the binding of lysine to plasminogen and moving into active form – plasmin, and in higher doses performs inhibition of plasmin activity. Objectives: To present our experiences in the application of tranexamic acid in reducing intra and post-operative bleeding, as well as complications, compared to patients to whom tranexamic acid was not applied. Materials and methods: We observed 80 patients who underwent hip and knee arthroplasty at the our Department for the period November 2013-May 2014. They were divided into two groups – 40 patients treated with tranexamic acid (Group 1) and 40 patients to whom tranexamic acid was not administered (Group 2). Laboratory parameters were monitored (RBC, Hgb, Htc preoperatively and postoperatively), the occurrence of increased or prolonged bleeding, the amount of required units of blood and blood derivatives, postoperative hematoma size and appearance of thromboembolic complications (ultrasound control after a month). Results: Mean preoperative values of monitored parameters in both groups were within reference values. Mean postoperative values of Hgb, RBC and Htc were closer to the reference values in the Group 1. Also in the Group 1 significantly less intraoperative bleeding and postoperative loss on drain were seen. To patients in Group 1 a total of seven units of blood and blood derivatives (0.18 U per patient) were administered, while the patients in Group 2 received 51 units (1.3 U per patient). In Group 1 significant reduction in the size of postoperative hematoma was observed. Conclusions: The use of tranexamic acid significantly reduces intra- and post-operative bleeding, the use of autologous transfusion sets, the need for blood and blood derivatives, as well as related complications. On the other hand there is economic importance of tranexamic acid use.

Download document

Institution: KB Sveti Duh

Country: Croatia

E-mail: gvrgoc@gmail.com

Title: First metatarsal head osteotomy for the correction of moderate hallux valgus with and without lateral release

Abstract: Introduction: Hallux valgus (HV) presents one of the most common deformities of the foot. In this study we compared patients with or without lateral soft tissue release (LSTR) undergoing Austin procedure in treatment of moderate hallux valgus deformity. Methods:We had two groups of patients, Group I consisted of 23 patients (25 feet), average age 55 (range, 43 to 77) years, which underwent Austin osteotomy alone (without LSTR); and Group II which consisted of 18 patients (23 feet), average age 59 (range, 52 to 70) years, which underwent Austin osteotomy with LSTR. X-ray imaging of the feet in weight bearing antero-posterior (AP) and latero-lateral (LL) projection were done in all patients preoperatively and postoperatively and Hallux Metatarsophalangeal-Interphalangeal scale (AOFAS Hallux MTP-IP) scoring postoperatively. We measured hallux valgus angle (HVA), intermetatarsal angle (IMA), proximal articular set angle (PASA), distal articular set angle (DASA) and measurements of the position of medial sesamoid bone on AP weight bearing radiograph using modified Hardy and Clapman system. Patient’s postoperative satisfaction survey was also performed. Results:In both groups HVA and IMA improved on postoperative X-rays. Significantly better results of the medial sesamoid bone position on X-rays was achieved in Group II. Patients\’ satisfaction score as well as AOFAS Hallux MTP-IP survey score was higher in Group II. The results showed significant improvement of PASA postoperatively in both groups. Conclusion:We may conclude that distal metatarsal osteotomy for moderate HV deformity correction combined with LSTR provides better results than procedure without LSTR in terms of improved X-ray together with overall patient’s satisfaction score.

Download document

Institution: General Hospital Jesenice

Country: Slovenia

E-mail: pcvijic@gmail.com

Title: The “peg” arthrodesis of the interphalangeal joints of toes

Abstract: Introduction The pin fixation of the interphalangeal joint arthrodesis of the toes was golden standard of the treatment of the static toe pathology. Loosening infection and poor compliance of the elderly patients are reasons for searching new ways of fixation One possibility is the “ peg ” arthrodesis. Materials and methods Between September and November patients ( male women feet ), age range – years average were operated in this manner refused the procedure had ” peg ” only on toe on two and on three toes females were operated on both feet patients had previous correction of the hallux. On occasions ” peg ” was combined with other procedures on the toes DIP joints were fused in patient PIP in male had posttraumatic deformation of the nd toe male had post infection nd toe deformation after the Homman procedure with pin fixation. All others had degenerative deformations patients had major cardiovascular disease diabetes hypertension hypercholesterolemia, but none had complications during the procedure. All patients were treated on the outpatient basis all but two in local anaesthesia. Those two preferred general anaesthesia The “ frog mouth ” skin incision was made over the contracted and painful joint the extensor tendon transversely cut and the joint opened The “ peg ” was formed from the head of the proximal and “ socket ” in the basis of the distal phalanx of the involved joint The “ peg ” was inserted into the “ socket ” and secured with the extensor tenodesis. Skin was closed with stitches X rays were made The toe was bandaged with adjoining toes for weeks Patients were instructed about the drapings mobilisation of the toes and burdening of the foot Draping changes and suture removal were done by general practitioner. Follow up was from months to years.

Download document

Institution: Centro Hospitalar de Vila Nova de Gaia Espinho

Country: Portugal

E-mail: tiagocpt@gmail.com

Title: Hip Arthroscopy In The Treatment Of Femoroacetabular Impingement

Abstract: Introduction: The femoroacetabular conflict is recognized as a cause of hip pain in young patients . It occurs due to repetitive contact between the proximal femur and the acetabular rim usually in the presence of structural abnormalities of the hip . It probably represents the most common mechanism leading to early development of labral and chondral injury. Treatment leads to significant clinical improvements and may prevent the progression of these lesions Objectives: Revision of 42 patients who underwent hip arthroscopy due femoroacetabular conflict. Methods: Patients were followed for 30 months. In the evaluation , the functional scores Non Arthritic Hip Score ( NAHS ) and Modified Harris Hip Score ( MHHS ) pre and post operatively were used . Results: There was a positive clinical evolution of 73.75 NAHS (mean) having a pre -operatively and post -operatively and 92.5 MHHS 27 and 34 in the preoperative postoperatively . There was a favorable radiographic outcome with a centre edge angle of 35 and an alpha angle of 43 . Discussion : Conventional arthroscopic techniques can produce favorable results in pain relief and correction of deformity associated with femoroacetabular conflict. There is no data available in the literature demonstrating the results of conservative treatment in symptomatic patients . The successful intervention relies on early detection and correction of mechanical complete what can be achieved by arthroscopy. Conclusion : Arthroscopy may be an effective method for treating deformity related to femoroacetabular impingement.

Download document

Institution: Centro Hospitalar Tondela Viseu

Country: Portugal

E-mail: tiago.rebelo@gmail.com

Title: Atypical femur fracture as a result of long term biphosphonates therapy

Abstract: Introduction: Bisphosphonates are a safe drug, well tolerated and with demonstrated efficacy. Regardless of that, there are increasing reports of atypical femur fractures (AFF) associated with long-term therapy with this class of drugs (over 5 years). It is thought that the lesion mechanism is related to the prolonged suppression of bone remodeling, changes in collagen pattern and bone vascularization alterations. Material and Methods: The authors describe the case of a of 72 years-old female, treated with alendronate for the past 8 years. The patient was taken to the emergency room for sudden pain in hip and tight without associated trauma. X-ray showed a subtrochanteric fracture of left femur. Was treated with a short Gamma Nailing and suspended the treatment with alendronate. 3 years after the patient suffered minor trauma to the lower limbs which resulted in bilateral femur shat fracture. The patient was treated with bilateral anterograde femur nailing. Results: There were no complications in the immediate post-operative, the patient initiated physiotherapy and gait training with crutches in the 3th day after surgery and after 3 months the patient has no pain or functional impairment. Discussion: Despite of the rarity of this type of fractures, they are becoming increasingly more frequent with the widespread of bisphosphonates therapy. The optimal duration of treatment with bisphosphonates remains controversial. There is no contraindication for the long.-term therapy with bisphosphonates. Take home message AFF are relatively rare events, and the balance between patient efficacy and safety still favors bisphosphonate therapy for the treatment of osteoporosis, despite that a drug holiday period should be considered in patients who take bisphosphonates longer than 5 years.

Download document

Institution: John Radcliffe Hospital Oxford

Country: United Kingdom

E-mail: kbutler1@doctors.org.uk

Title: Case Report: Man Versus Digger

Abstract: A 28 year old fit, healthy male sustained multiple injuries caused by blunt trauma from the scoop of a digger. He presented haemodynamically unstable with severe pelvic, abdominal and thoracic injuries. He was stabilised and further imaging found a traumatic hemipelvectomy, damage to the external iliac vessels, a diaphragmatic hernia and an abdominal wall hernia. He underwent emergency fixation of the pelvis with an external fixator and sacroiliac screws and was then admitted to the Intensive Care Unit which gave time for discussion and planning of the next step in his care. He later underwent a four compartment fasciotomy but unfortunately after days of treatment we had to proceed to an above knee amputation due to ischaemia and rhabdomyolysis. Acute tubular necrosis secondary to his rhabdomyolysis complicated his treatment as well as dietary intolerance. He had to start regular dialysis and required extensive amounts of rehabilitation. This is a severe polytrauma case with many unfortunate, but some predictable, complications. The discussion addresses the possible management plans and rationale behind the management of this patient and his injuries.

Download document

Institution: Kerry general hospital

Country: Ireland

E-mail: nouman142@gmail.com

Title: Our experience of Achilles tendon repair absorbable vs non absorbable suture repair.

Abstract: Background – We retrospectively studied our Achilles tendon acute rupture cases done over past 2 years and reviewed the outcome and complications. Methods: The inclusion criteria was acute rupture, 18 yrs or older and with complete Achilles rupture. 57 pts were included who completed the criteria ranging from 20 to 75.There were 38 male and 19 female patients. We did open end to end repair. We retrospectively collected their bio-data, medical history and mode of treatment .We followed them over up to 6 months with regards to outcome and complications.The boyden score was estimated at their follow up visits. Results: RESULTS- Out of 57, 4 were treated conservatively because of their medical co-morbidities, age and functional requirements.53 were operated using ETHIBOND Suture (a non absorbable, braided, sterile, surgical suture composed of Poly -ethylene terephthalate) and PDS (POLYDIAXANONE-monofilament synthetic absorbable suture) or only PDS . Complications- Intra-op and post op complications were recorded.The post op complications were divided on early and late complications.About 6 surgical infections of the operative site and 2 complications over longer period came as thickening and stiffness. Conclusion: Conclusion- We came with this outcome that in majority of patients the functional outcome results were good to excellent .We observed that a particular technique of repair was related to infection rate as all of them who got infection were repaired using ethibond. We also observed that dvt prophylaxis should be regularly give in the patients.

Download document

Institution: Sv. Katarina

Country: Croatia

E-mail: andrej.radic@svkatarina.hr

Title: Cartilage and ligament injury after patellar dislocation diagnostics and treatment

Abstract: Introduction Even today, in many Croatian hospitals MRI scan is not standard diagnostic procedure after patellar dislocation. On rare occasions, small patellar flake fractures can be found on radiographs which indicate cartilage injury. Without MRI we can miss important accompanying cartilage injuries, usually located at medial patellar facet and lateral femoral condyle. Therefore, every patient with patellar dislocation should have an MRI. Beside cartilage injuries, bone edema as well as medial patellofemoral ligament rupture can be found on MRI scans. These injuries with verified loose bodies will be indication for surgical treatment. Materials and methods Our patient was 13 years old girl that had her first time patellar dislocation during jazz dance. On MRI scans we found osteochondral fracture of the lower part of the medial patellar facet, two free osteochondral fragments, incomplete rupture of the medial patellar retinaculum as well as bone contusion edema at lateral part of lateral femoral condyle. Damaged cartilage at medial facet patella was arthroscopically debrided and microfractures were performed. Subluxated patella was repositioned over femoral trochlea using Yamamoto procedure. Results After 4 months, on follow up MRI, cartilage patellar defect was replaced with fibrocartilage scar tissue and patella was over trochlea. Clinically apprehension test was negative. Discussion Not every patellar dislocation needs operative treatment. After MRI and analysis of injured elements we can decide about further treatment. In this case, indication was cartilage injury, medial patellofemoral ligament injury, loose body and lateral subluxation of patella over femoral trochlea. Take – home message Careful analysis of MRI scan and evaluation of injured knee elements can facilitate decision making for operative treatment.

Download document

Institution: Institute of Orthopedics, physical medicine and rehabilitation Dr. Miroslav Zotović

Country: BiH

E-mail: pcvijic@gmail.com

Title: MPFL reconstruction with gracilis muscle tendon

Abstract: Introduction: The primary role of the medial patellofemoral ligament (MPFL) is in preventing of lateral dislocation of the patella. Indication for operative treatment is recurrent lateral patellar instability. Contraindications are skeletal immaturity, Q angle grater than 20°, patella alta and significant arthrosis. Objectives: Monitoring of patients treated surgically after the reconstruction of the MPFL with m. gracilis tendon, and their return to normal activities Materials and methods: The analysis included 46 patients (17 men and 29 women) operated in our hospital from June 2011.-December 2014. Reconstruction of the MPFL was performed with m. gracilis tendon with arthroscopic control in all patients. Parameters were obtained with clinical examination before and after surgery. Results: The average follow-up period was 12.6 months (10 to 24 months). Apprehension test was positive and MRI indicated a lesion MPFL in all patients preoperatively. Apprehesion test was negative and there was no clinical hypermobility of the patella in all patients postoperatively. We had one complication due to graft tightened too much that we have solved with relaxation of the part of graft fibers. This complication was clinically manifested by pain in the operated knee during flexion. Conclusions: Reconstruction of the MPFL with m. gracilis tendon is not a complicated procedure and has a low complication rate. Minimum of implanted material is necessary for this procedure. The most important moments of the operation are the positioning of the graft in isometric points and the determination of graft tension.

Download document

Institution: OB Sisak

Country: Croatia

E-mail: zjelec@yahoo.co.uk

Title: A rare clinical entity unrecognized posterior dislocation of the shoulder a case report

Abstract: Posterior dislocation of the shoulder is a rare clinical and radiological entity. It accounts for less then 2 % of all dislocations of the shoulder. Method of treatment is determined by the size of the defect and the duration of dislocation. We present a case of a 66-year old woman with unrecognized posterior dislocation of the shoulder after falling from a bicycle. Following a CT scan we performed an open reposition of the humeroscapular joint and transposition of the upper third of subscapularis tendon into the humeral head defect. Ten months after surgery we found a good range of motion and the patient is very satisfied with the final result of the surgical treatment. The treatment of unrecognized chronic posterior dislocation of the shoulder is difficult. We believe that after detailed clinical examination, a good diagnosis and accurate assessment of the defect on the articular surface of the humeral head and the correct selection of treatment methods, posterior shoulder dislocation can be treated successfully, not only in highly specialized orthopaedic clinics, but also in regional and general hospitals.

Download document

Institution: KBC “Sestre milosrdnice”

Country: Croatia

E-mail: majadinkic@gmail.com

Title: Isolated traumatic dislocation of the fifth carpometacarpal joint: a case report

Abstract: Isolated ulnar dislocation of the fifth carpometacarpal joint without associated fractures is a rare injury and the scientific literature contains very few published reports of cases of this particular injury. The injury is frequently overlooked in the routine diagnostic X-ray. Timely and accurate diagnosis of the injury is crucial as the treatment is usually surgical. In this report, we present a case of isolated ulnar dislocation of the fifth carpometacarpal joint, secondary to an injury by a baseball bat, treated by reposition and percutaneous K-wire fixation which resulted in a satisfactory radiographic and clinical outcome.

Download document

Institution: Centro Hospitalar de Vila Nova de Gaia Espinho

Country: Portugal

E-mail: miguelmcfrias@gmail.com

Title: Arthroscopically Assisted Double-Button Acromioclavicular Reduction, How Far Can It Resist?

Abstract: The acromioclavicular (AC) joint dislocation usually occurs in young adults as a result of direct high-energy trauma. There are several surgical options available, and the techniques associated with arthroscopically-assisted mooring systems with double cortical button is now an option with overlapping results to techniques traditionally used, with rare complications described. However, and despite its increasing use, its risks and benefits remain poorly clear. Adult male, 49 years old, physical education teacher, bicycle accident, appeara to the emergency department and was diagnosed with a left AC dislocation grade III (Rockwood classification). Taking into account the patient\’s activity it was decided to surgical reduction and fixation assisted by arthroscopy with dual button cortical system. At 7 months postoperatively he suffers another fall with fracture of the middle third of the same clavicle, group I according to Allman Classification. It was decided to treat nonoperatively with a figure-of-eight bandage for 4 weeks. At 6 months postoperatively had a Constant Index of 78, having returned to his previous active sporting life, with no surgical complications observed. After 4 months of the clavicle fracture, and 1 year after the initial AC dislocation, returned to the previous labor activity presenting a Constant Score of 82. After 2 years of follow-up the patient presented with a Constant Score of 94 and he was free of shoulder pain with no restriction on his work and sport activity. No loss of radiograph reduction or AC joint degeneration was observed. Currently, no clinical midterm results have been reported on arthroscopically assisted reduction of the acutely dislocated AC joint using double-button devices for fixation. However, it appears to be a reliable and robust system, with a favorable recovery and return to previous activities.

Download document

Institution: Centro Hospitalar de Vila Nova de Gaia Espinho

Country: Portugal

E-mail: miguelmcfrias@gmail.com

Title: Clavicle fractures surgical management – a retropective clinical study

Abstract: The clavicle fractures account for about 2.5% of all fractures, its higher prevalence affects young male, and is usually associated with high kinetic trauma. The middle third fractures are the most common, followed by fractures of the distal third and, rarely observed, fractures of the medial third. In most cases the treatment is conservative. However, more recently the evidence suggests that conservative treatment, especially the middle third fractures with deviation or shortening, is not as favorable as previously thought, with rates of nonunion reaching 15% in some studies. Were studied retrospectively 36 patients from January 2009 to December 2013. The inclusion factors selected were a deviation or initial shortening greater than 20 mm or skin tenting undergoing primary fixation with plate. Of the total patients evaluated, most were male with a mean age of 38 years and a mean follow-up of 11 months. Of the aforementioned complications, it was found only one case of superficial infection of the surgical wound and four cases of material extraction due to a prominence of the plate. The mean Constant index was 85 points, with almost all of the patients satisfied with the results. Despite conservative treatment is still considered the treatment of choice, in appropriately selected individuals, surgical treatment may be safe and effective bringing with it favorable results.

Download document

Institution: KBC “Sestre milosrdnice”

Country: Croatia

E-mail: stjepancuric@yahoo.com

Title: Management of reversed bennett’s fracture in university hospital centre „sestre milosrdnice” in time period from 2012 – 2014

Abstract: OBJECTIVES: Dislocation fracture of the fifth metacarpal base is pathologically and radiographically similar to the Bennett’s fracture of the thumb metacarpal, and it is known as a „Reversed Bennett” or „Baby Bennett”. The aim of this study is to show our experiences with mentioned fractures and benefits of its surgical treatment. PATIENTS AND METHODS: A retrospective study was conducted, consisting of 78 patients, 21 to 75 years of age, with intra-articular fracture of the fifth metacarpal base, between January 2012 and December 2014. 61 patients were conservatively treated with casting, while other 17 patients had indication for surgical treatment. Indication was set according to 5 degrees of angulation and 1-2 millimeters of dislocation. Surgical treatment included percutaneous K wiring (9), twin fix/mini Herbert screw (6) and AO screw (2). RESULTS: After a mean of 12 months, we reviewed 17 patients that were surgically treated. The overall results were satisfactory with all applied methods, since all patients had improved range of motions of metacarpophalangeal flexion and extension and showed significantly powerful grip. However, the best results reviewing postoperative abduction were noted with applied twin fix/mini Herbert screw. CONCLUSION: Open reduction and internal fixation with K wires, twin fix/mini Herbert screw and AO screw are all good techniques for surgical treatment of intra-articular fifth base metacarpal fracture, when right indication is set. However, the debate between closed reduction with casting versus operative management continues. Until a large-scale study comparing these two treatment options is completed, a surgeon\’s personal preference will continue to be acceptable as a standard of care.

Download document

Institution: KBC “Sestre milosrdnice”

Country: Croatia

E-mail: pjurinac@gmail.com

Title: Operative fixation of the isolated 4th metacarpal shaft fracture in recreation athletes

Abstract: Introduction: Metacarpal fractures are common injuries, which appear in general population, as well as in the population of athletes. The aim of this study was to present a series of isolated 4th metacarpal shaft fractures exclusively in the population of recreation athletes, which were surgically treated and time-frame of their return to every day activities according to applied measures of treatment and postoperative care. Materials and Methods: A retrospective single center study was conducted, including patients with isolated 4th metacarpal shaft fracture, which occurred during the two-year period, from January 2010 to December 2011. Inclusion criteria were: isolated dislocated 4th metacarpal shaft fracture, acute injury with onset no longer than 10 days before admitting to hospital, recreation athletes and participants younger than 40 years of age. All patients were surgically treated. The choice of internal fixation was made between low profile plates and fixation with 2 or 3 mini-screws. All patients followed standard rehabilitation protocol with early mobilization. Results: The mean follow-up of the patients was 12 months. After completed physical therapy, range of motions of metacarpophalangeal flexion and extension was increased and early return to normal daily activities and sports practice was allowed. No complications were noted, all fractures healed, without any signs of infection, non- or malunion. Conlusion: Surgical treatment of the 4th metacarpal shaft fracture with low profile plates and mini-screws is a good technique that represents rigid fixation and provides fast recovery to pre-injury range of movements. Quality of life is enhanced, due to fast recovery and return to normal daily, as well as sports activities. Such treatment indicates profitability, hence to a one-day surgery, descreasing treatment costs and resulting in high beneficial aspects for patients.

Download document

Institution: Centro Hospitalar de Vila Nova de Gaia Espinho

Country: Portugal

E-mail: ricardo.s.pereira@gmail.com

Title: Parsonage–Turner syndrome after Anterior Shoulder Dislocation

Abstract: Parsonage – Turner syndrome is an extremely rare and serious disorder of unknown etiology with asymmetric inflammatory involvement of the brachial plexus. Although the etiology of the syndrome is still unclear it is reported in various clinical situations including postoperatively, postinfectious, posttraumatic, and postvaccination. We aim to present a case of a 65 year old female woman who presented to our emergency room with an isolated anterior dislocation of her right shoulder after a simple fall. After adequate reduction she was immobilized with a Velpeau-type dressing and discharged with no neurovascular deficits. The patient was reevaluated on an outpatient basis three weeks after the fall and presented with drop arm and complete inability to mobilize the right upper limb. She also made reference to progressive shoulder and arm pain that had initiated a few days after the initial injury and resolved spontaneously by then. Detailed neurologic examination revealed severe right brachial plexus injury with motor weakness and abolished reflexes in the muscles enervated by C5 C6 and C7 right nerve roots. There was also hypoesthesia in the C5 C6 C7 and T1 dermatomes. Electromyography revealed severe axonal lesion with active denervation of all the upper limb muscles compatible with brachial plexus injury or severe neuropraxis due to entrapment. Brachial plexus MRI showed intramuscular edema and atrophy of the supraspinus, infraspinus, teres minor and deltoid with perineural edema of the brachial plexus. There were no indirect signs of avulsion of the nerve roots or any image of entrapment or compression of the brachial plexus from the cervical spine to the axillary region – these alterations were concluded to be a consequence of Parsonage-Turner type neuritis. To our knowledge this is the first case of Parsonage-Turner Syndrome described as a complication of shoulder dislocation.

Download document

Institution: KBC Zagreb

Country: Kuwait

E-mail: sandraslabe@gmail.com

Title: Frequency of infections in politraumatizied patients after operating treatment

Abstract: This study is performed by a theatre scrub nurse about frequency of infections in polytraumatised patients. Primary aim of the study was to evaluate the incidence of wound infections and infections of urinary tract, pneumonia and sepsis in polytraumatised patients treated at the Department of Surgery in University Hospital Center Zagreb and in the operating unit of the department in one year period. Secondary goal was to asses the quality of nurses\’ work and care in the operating unit and to evaluate possibilities for improvement. Results of the study confirmed that frequency of infections is not dependent on quality of our work and care but on numerous associated risk factors in this critical patients; but there are still some possibilities for improvement which nurses can implement to improve standards of work and care in the operating theatre. KEY WORDS: politrauma, infections, operating treatment, theatre scrub nurses.

Download document

Institution: Jahra Hospital

Country: Kuwait

E-mail: fkhalaf2000@yahoo.com

Title: The effect of induced brain injury and spinal cord injury on the union of femoral osteotomy in rabbits

Abstract: In prospective controlled study, we tested the effect of induced brain injury and induced spinal cord injury on healing of femoral fractures in animals. 12 rabbits with brain injury and femoral osteotomy fixed with k-wire group (A) and 12 rabbits with dorsal spinal cord injury with femoral osteotomy and fixation group (B) were followed-up radiologically 3 and 6 weeks and compared to control group of 12 rabbits with femoral osteotomy and fixation only group (H). 24 rabbits with femoral osteotomy, fixation and 1 ml serum allograft from brain injury rabbits on a carrier in 12, group (C) and from spinal cord injury in 12, group (D) compared to control groups of 48 rabbits in groups (E) to (H). Group (A) and (B) rabbits showed early union callus in 3 weeks in 20 rabbits (83.3%) and all osteotomies united in 6 weeks with abundant callus, while group (H) rabbits showed 6 nonunion (50%). It was found that sera from rabbits with inflicted brain or spinal cord injury have no osteogenic effect on femoral osteotomy of other rabbits. We concluded that central nervous tissue damage enhances bone healing and serum from rabbits with brain or spinal cord injury has no osteogenic effect.

Download document

Institution: Poliklinika Marin Med Dubrovnik

Country: Croatia

E-mail: niksako@hotmail.com

Title: „Bio-logical“ carbon fiber peek intramedulary nailing for humeral shaft fractures – international multi-center experience

Abstract: Traditional metal alloys used in IM implants have a Young modulus – times greater than surrounding bone which may be causative to delayed union non union and re – fracture of the bone. A newly designed implant CFR – PEEK IMN „ Piccolo “ humeral nail ( Carbo – Fix Orthopedics ltd ) is made of % continuous ( endless ) carbon fibers embedded in % Polyaryl – Ether – Ether – Ketone ( PEEK ) matrix. Mechanical testing showed that CFR – PEEK implant to be as efective as metal devices in provision of intramedullary stability however due to low elastic modulus similar to cortical bone it is expected to lessen the degree of stress shielding therefore expedite bone healing and lower the incidence of non – union and re – fracture. Due to it’s radiolucency CFR – PEEK implant allows superior radiographic visualsation both intraoperatively and at later follow up or during CT or MRI imaging This work demonstrates cumulative multicenter experience gained since „ Piccolo “ CFR – PEEK nail was introduced in June Multicenter study comprised patients with humeral shaft fractures and in all patients „ Piccolo “ nail was implanted using standard antegrade approach. Mean operative time was minutes and mean x – ray exposure time during surgery was sec. No intra – operative complications were recorded. Healing of fracture sites was observed through callus formation progress stated as no callus fair callus and good callus „ fair “ callus was observed at ± days ( range to ), and to show progression to „ good “ callus ± days ( range to ). Regardless of relatively small cohort of this study and it’s retrospective design promising data were generated through observed ease and safety of implant use and appropriate fracture.

Download document

Institution: Centro Hospitalar de Vila Nova de Gaia Espinho

Country: Portugal

E-mail: ricardo.s.pereira@gmail.com

Title: Painful Nonunion After Missed Juvenile Tillaux Fracture In An Athlete – Description Of New Fixation Technique With Soft Suture Anchor

Abstract: Introduction: A juvenile Tillaux fracture is a relatively uncommon avulsion fracture of the anterolateral corner of the distal tibial epiphysis that occurs in adolescents. Surgical treatment is recommended in acute cases with more than 2 mm displacement There are no published reports on the management of nonunion after a missed juvenile Tillaux fracture in an athlete. Objectives: We aim to present a case of a 14 year old female competitive basketball player that was initially diagnosed with a mild ankle sprain after sustaining a forced external rotation type of injury. Because of persistent ankle pain and inability to return to her sporting activity the patient was referenced to our institution where radiographs and CT-scan showed a small minimally-displaced Tillaux fracture. A course of conservative treatment with 6 weeks non weight-bearing in a short-leg cast followed by a progressive rehabilitation protocol were unsuccessful in returning the athlete to full sporting activity. At 6 months after the initial injury another CT-scan was performed showing nonunion of the fracture and operative treatment was decided. Methods: The patient was treated with open reduction and, because of the small size of the epiphyseal fragment, soft anchor fixation was prefered over the more common lag screw fixation. The anchor was placed immediately medial to the anterolateral fragment and anatomic reduction was mantained with a braided suture strand passed in a figure-of-eight manner through the antero-inferior tibiofibular ligament. Results: The patient was full weight-bearing by the 10th week and returned to her previous sporting activity level with no complaints by the 14th post-operative week. Conclusion. Suture anchor fixation of a Tillaux fracture may be a viable option when the anterolateral physeal fragment is too small for lag screw fixation.

Download document

Institution: William Harvey Hospital

Country: United Kingdom

E-mail: s.kechyn@doctors.org.uk

Title: Do patients with hip fractures admitted over the weekened have worse outcomes compared to those admitted on weekdays; a retrospective case control study.

Abstract: The concerns about patients having worse outcomes if they were admitted over the weekend are not novel, and multiple reports have looked into that. The authors have elected to specifically target the patients admitted with hip fractures, as they commonly are elderly with multiple comorbidities, and keen pre-operative and post-operative care is prudent for them. We have underwent a retrospective comparative study, in which we identified a cohort of 64 patients admitted with hip fractures over the weekends of the period extending between August 2013 and May 2014, and retrospectively compared their outcomes in terms of length of hospital stay, inpatient mortality, and destination of discharge, to those of a randomly chosen cohort of 64 hip fracture patients admitted over the weekdays of the same period. The results revealed that the length of hospital stay was similar in both groups, however there was a statically significant increase of in-hospital mortality, and decrease in the number of patients discharged directly from the hospital to their homes among the weekend group in reference to the the weekdays group. In conclusion our data suggest that patients admitted with hip fractures over the weekend are likely to have worse outcomes compared to their weekdays counterparts, yet we accept that our cohort sizes are relatively small and further work should ensue.

Download document

Institution: Galway University Hospitals

Country: Ireland

E-mail: michaelosullivan86@gmail.com

Title: The impact of the Irish economic recession of 2008 and the evolution of spinal surgery in the West of Ireland 2005 2013.

Abstract: The impact of the Irish economic recession of 2008, and the evolution of spinal surgery in the West of Ireland, 2005-2013. Background To determine the impact The Irish Economic Recession of 2008 and the associated service restrictions, in the short and long term, on the trends within the practice of spinal surgery in Galway University Hospitals (GUH) over a 7 year period, January 2005- January 2013. Methods A retrospective review of all spinal cases conducted in both GUH hospitals was recorded for the years 2005, 2006,2008,2009,2012 and 2013 respectively. Characteristics of the spinal surgery performed where recorded. They included, Anatomical Region, the use of instrumentation,the number of levels spinal accessed , and pathology treated. Statistical Analysis was performed using R and Excel Statistical Analysis for graphs. Poisson regression was used for absolute numbers. Chi-squared test was used for trends in ratios. Two-tailed tests used with p value < 0.05 considered for statistical significance. Results On analysis of the trends in spinal surgery during the study period we found that there has been statisctically significant (p < 0.05) increase in all aspects of spinal surgery with the exception of surgeries for single level ,lumbar and infection pathology respectively. Conclusion The volume and complexity of spinal surgery has increased during the study period.Trends towards multilevel and instrumented spinal surgery is undeniable. Based on these results spinal surgery appears to be refractory to economic recession in the West of Ireland.

Download document

Institution: Isar Klinikum Munich

Country: Germany

E-mail: hellinger@gmx.de

Title: 4 years outcome after microtubular disc decompression with radiowave disc treatement for herniated discs

Abstract: Purpose A high – frequency radiowave system which combines with a manual microtubular nucleotomy for the treatment of degenerative disc disease and herniations of the lumbar spine has been developed In this investigation we have collected clinical data on efficacy and safety of high radio frequency ablation in conjunction with a manual discectomy of the lumbar intervertebral disc over a year period Methods patients with radicular pain syndromes due to a contained herniated disc were enrolled in this prospective clinical study Patients underwent a spinal procedure during which the disc herniation was treated with a manual discectomy and high radio frequency ablation using a microtubular approach Outcomes were assessed at weeks months year years and years postoperatively by using the VAS score for back and leg pain the McNab index and SF Results year clinical results on patients ( % follow Up ) were available for evaluation According to the VAS Scale back pain improved from a total of to and leg pain from to % of the patients were very satisfied or satisfied with the outcome of the surgery The quality of life score showed that % were satisfied with their current quality of life SF McNab also showed very good postoperative results After years the long – term reoccurrence rate was %. Conclusions The clinical results after years with high radio frequency ablation during manual discectomy for herniated disc are encouraging

Download document

Institution: Isar Klinikum Munich

Country: Germany

E-mail: hellinger@gmx.de

Title: Is there a place for minimal invasive and endoscopic surgery on the lumbar spine Are there any advantages for the future

Abstract: At the end of the 80ies the technology for endoscopes made a step forward what leaded to a recovery for the neuroendoscopy. On the spine surgeons like Kambin, who made the first working channel scope for disc herniations, gave it a new input. This step was made by the confrontation with disadvantages of open surgery and the goal to minimize the surgical morbidity by using the new techniques of visualisation and surgery. We can demonstrate this on the MRI measurement of muscle demages compared to open microdissectomy. The endoscopic surgery of the spine allows a minimal surgical trauma on the approach, to do surgery only in the region of pathology even under local anaesthesia, avoids postagressive metabolism and gives a fast recovery to the patient. At all it is a minimal aggressive surgery. To do these techniques special skills, trainings and knowledge are required. Also the use of the new technical possibilities must be learned. Meanwhile exist a lot of different endoscopic techniques on the lumbar and cervical spine. Especially the differnet approaches, transforaminal, interlaminar, translaminar on the lumbar spine as well as the anterior or posterior on the cervical spine must be common for an endoscopic surgeon. This demands often a shallow learning curve. Nowadays all kinds of discal pathologies beside stenosis can be treated by endoscopy. The value of these techniques has been proofed in a lot of scientific papers. Randomized controlled studies are available beside our dayly experience Here is not only the outcome, without any inferiority of the endoscopic surgery, an important parameter. The endoscopic surgery of the spine today is a less traumatic and effective option for the surgery of the spine beside the classical microsurgery.

Download document

Institution: General Hospital Celje

Country: Slovenia

E-mail: ninomirnik@gmail.com

Title: E poster

Abstract: Purpose This study prospectively analyzed the success rates of DLSS patients treated with decompression and implantation of a soft IPD at one or two levels We compared the results with a historic group of patients treated with traditional surgical decompression with or without PL fusion at one or two levels Methods In the DIAM group outcomes were measured with the Zurich Claudication Questionnaire, Oswestry Disability Index (ODI ) and the Short Form Health Survey ( SF – ) completed preoperatively and at and months postoperatively In the historic group outcomes were measured with the ZCQ preoperatively and at months The two groups were compared in ZCQ results preoperatively and at months Results The operating time was (± ) minutes in the DIAM and (± ) minutes in historic group The blood loss was (± ) ml in the DIAM and (± ) ml in the historic group The hospital stay was (± ) days in the DIAM and (± ) days in the historic group The narcotic use was (± ) days in the DIAM and (± ) days in the historic group In overall ZCQ results % ( ) in the DIAM group and % ( ) of the patients in the historic group were considered to be clinically successful In the DIAM group the ODI and SF – results significantly improved on follow – up at months and continued to improve to a – years observation period Conclusion Overall the adjunct of a soft IPD to the interspinous decompression has not provided patients with better results in comparison to traditional surgical methods The main advantages of interspinous decompression coupled with soft IPD implantation for DLSS are less operating time less blood loss and less narcotic use which may make this surgical method potentially usable in older, debilitating patients.

Download document

Institution: Military Medical Academy Sofia

Country: Bulgaria

E-mail: physioana@web.de

Title: Range of motion and muscle strength improvement using elastic resistance and kinesiotaping after operative treatment of the fractures in the elbow field.

Abstract: The posttraumatic contractures and muscle strength of the elbow complex represent a serious medico-social problem.The functional insufficiency leads to inability of independently performing of basic daily activities and sports.The elbow joint is the most complicated big joint.By 50% restrictions of the elbow function may result up to 80% difficulties of the upper limb movements.The post traumatic contractures are flex ion-extension or combined.The extension is more frequently affected,and its recovery is more difficult.Main cases for decreased ROM and muscle strength are postoperative immobilization,pain and the increased muscle tons of m.biceps brachii and m.triceps brachii. Material and Method: The elastic resistance and kinesiotaping methods were applied to 20 patients with fractures of the elbow,of which 15 men and 5 women treated surgically in the Department of Orthopedic,Traumatology and Reconstruction Surgery,Military Medical Academy,Sofia,and Nord-West Krankenhaus ,Frankfurt in physiotherapy department.For evaluation of the functional results were used the following methods:Manual Muscle Testing,VAS for pain,goniometry.Specialized exercises with Elastic resistance and kinesiotaping were included in the physiotherapy program which started on 7th postoperative day. Results and Analysis: The analysis of the data from the last follow up demonstrated excellent functional results (statistically significant)in terms of muscle strength,range of motion and elbow complex. Conclusion:The specialized exercises with elastic resistance and kinesiotaping are integral part of modern methods off physiotherapy supporting the rapid functional recovery of the patients,due to its diversity,possibilities varying in the degrees of elastic traction and financial affordability.

Download document

Institution: Sv. Katarina

Country: Croatia

E-mail: eduardrod1508@gmail.com

Title: “Same Day” ex vivo regional gene therapy: The optimization of the human skeletal muscle transduction with recombinant adenoviral vectors

Abstract: Introduction: The conventional, two step approach, ex vivo gene therapy is expensive and time consuming procedure. Successful clinical applications needs ex vivo gene therapy protocol in which all procedure would be performed in operating theatre during surgical procedure. Aim: To optimize the transduction of grafts of human skeletal muscle with a recombinant adenoviral vector constructed to carry the luciferase reporter gene (Ad.Luc 2) in vitro. Adenoviral vector expressing osteogenic inducer BMP-2 (Bone Morphogenetic Protein) will be used to evaluate the effectiveness of the developed protocol. Material and methods: The ideal concentration of adenoviral particles, transduction time and influence of lanthanum chloride and/or calcium chloride on improvement of transduction was determined by luciferase report assay and the BCA protein assay. AdBMP-2 was used to evaluate the effectiveness of developed protocol. Quantitative PCR was done on day 0, 7 and 14 to confirm the expression of DMP1 (dental matrix protein) and BSP(bone sialoprotein). Results: The ideal concentration of adenoviral particles for transduction of human muscle graft was 10^9 PFU/mL. The optimal time of contact between human skeletal muscle graft and adenovirus concentration 10^9 PFU/mL was 30 minutes. There was no statistically significant difference between pure viral titer applied and supplemented viral titer applied to the muscle grafts. Effectiveness of the developed protocol was evaluated with comparing relative mRNA expression of BSP and DMP1 on day 0, day 7 and day 14 for adenoviral vector expressing osteogenic inducer BMP-2 (Bone Morphogenetic Protein) and osteogenic induction medium. Conclusion: This research, we have optimized protocol for in vitro transduction of grafts of human skeletal muscle with a recombinant adenoviral vectors.

Download document

Institution: KBC Zagreb

Country: Croatia

E-mail: kcrnogac@gmail.com

Title: Isolated Microorganisms from Allograft Femoral Head and Bone Chip Samples

Abstract: Femoral heads as allografts are routinely obtained from living donors during total hip arthroplasty (THA) and are a valuable source of bone grafts in everyday orthopaedic surgery. However, all these allografts need to be assessed for bioburden before transplantation. Aim of this study is to identify the most common microorganisms responsible for allograft contamination. Records of femoral head and bone chip banking between 2011 – 2013 were reviewed retrospectively. A total of 215 living donors, 115 females and 100 males (mean age 60.2 years; range 25-83 years), donated 200 femoral heads and 205 bone chips. They were all harvested during THA for primary or secondary osteoarthritis. Tissue samples of femoral heads and bone chips were separately obtained for bacterial and fungal bioburden testing. Microbiological growth was obtained from 24% of femoral heads and 11.7% of bone chips. We discarded 61 femoral heads and 55 bone chips. Fifty-seven femoral heads and 53 bone chips were discarded because of microbiological contamination and 4 femoral heads and 2 bone chips were discarded because of technical issues. The predominant microorganisms isolated were skin commensals like coagulase-negative Staphylococci found in 45 tissue samples followed by Corynebacterium species and Bacillus species in 6, and Streptococcus viridans in 4 tissue samples. Other microorganisms were only sporadically encountered. Isolated skin commensals and the fact that less than 1% of the femoral and bone chip donors eventually develop periprosthetic hip joint infection showed that contamination during handling, obtaining tissue samples and packaging rather than precedent local infection or transient bacteriemia is the main cause of allograft contamination. Decontamination methods could be applied during bone processing and could potentially decrease the contamination of the final bone products, but cost/effectiveness analysis should be performed first.

Download document

Institution: Medicinski fakultet Zagreb

Country: Croatia

E-mail: andreja_vukasovic@yahoo.com

Title: Bioreactor-engineered cartilage graft for osteochondral knee lesion – study in sheep

Abstract: The aim of this study was to apply bioreactor engineered tissue graft for the treatment of osteochondral defects in sheep stifle joint, thus enabling cartilage and subchondral bone restoration. 8 sheep were assigned to 4 treatment groups. All sheep underwent two surgical procedures. During the first procedure, chondral defects 4 mm in diameter were created on the weight bearing surfaces of both condyles of the right femur. After six weeks, all chondral defects were converted to osteochondral defects 6 mm in diameter and 5 mm deep. In groups NC (n=2) and AC (n=2) autologous three-dimensional osteochondral grafts engineered in perfusion bioreactor from bilayered scaffolds and nasal septum chondrocytes or articular chondrocytes respectively were implanted in the defect. In the CFS group (n=2) only bilayered scaffolds were implanted while CTR group (n=2) underwent defect conversion only (negative control). Three months after treatment surgery, all sheep were sacrificed and tissue blocks were obtained for histology analysis. The samples were fixed in 4% buffered paraformaldehyde and decalcified in 15% EDTA. Paraffin blocks were sectioned at 5 µm and stained with hematoxylin-eosin, safranin O and picrosirius Red. Immunohistochemistry was performed against collagen type I, II and aggrecan. Histology was evaluated with ICRS II histological score. Overall results showed that cartilage restoration was the best in NC group. Matrix staining, ICRS II parameter, scored superiorly in NC group (p < 0.05). The research leading to these results has received funding from the European Union\’s Seventh Framework Programme (FP7/2007-2013) under grant agreement n°278807.

Download document

Institution: Polytechnic of Zagreb

Country: Croatia

E-mail: pbonacic@tvz.hr

Title: 3D model visualization and analysis using Finite Element Method and 3D printing in medicine

Abstract: The power of advanced medicine is one of the great stories of modern science, built on a long succession of discoveries and technological breakthroughs. Medicine development lies in technology development. Modern manufacturing of medical supplies and medical diagnostics today can not be imagined without the use of modern tools such as computer programs for 3D modeling (SolidWorks, Pro/Engineer), simulation (Abaqus, Ansys), animation and devices for Rapid Prototyping (3D printer). This paper presents a simplified model of intravertebral artificial disc Charite, which is modeled in SolidWorks software package. The model is discretized tetrahedral finite element mesh of the second order, and the simulations were performed for four different loads in Abaqus. Using 3D printing, which is the base of 3D modeling, such a type of implants and prostheses will be produced in a very short time with a much lower costs, which will bring revolution and medical advances.

Download document

Institution: Medicinski fakultet Zagreb

Country: Croatia

E-mail: maja0502@gmail.com

Title: Cytokine expression in synovial membrane of sheep knee treated with tissue engineered osteochondral graft

Abstract: The aim of this study was to apply bioreactor engineered tissue graft for the treatment of osteochondral defects in sheep, thus enabling cartilage restoration, and examine tissue reactivity to this type of treatment. 8 sheep were assigned to 4 treatment groups. All sheep underwent two surgical procedures. During the first procedure, chondral defects 4 mm in diameter were created on the weight bearing surfaces of both condyles of the right femur. After six weeks, all chondral defects were converted to osteochondral defects 6 mm in diameter and 5 mm deep. In groups NC (n=2) and AC (n=2) autologous three-dimensional osteochondral grafts engineered in perfusion bioreactor from scaffolds with nasal septum and articular chondrocytes respectively were implanted in the defect. In the CFS group (n=2) only scaffolds were implanted while CTR group (n=2) underwent defect conversion only (negative control). 6 weeks after treatment surgery, all sheep were sacrificed and tissue blocks were obtained for histology analysis. The samples were fixed in 4% buffered paraformaldehyde and decalcified in 15% EDTA. Paraffin blocks were sectioned at 5 µm and stained with hematoxylin-eosin and against TNF-alpha. The amount of TNF-alpha, IL-1β and IL-6 mRNA expressed in synovial membrane of treated and contralateral knees was measured with qRT-PCR. Results showed moderate expression of all three cytokines with no significant difference among groups. The research leading to these results has received funding from the European Union’s Seventh Framework Programme (FP7/2007-2013) under grant agreement n°278807.

Download document

Institution: Emergency medicine centre of Montenegro

Country: Montenegro

E-mail: adzihan@gmail.com

Title: Contemporary approaches in using of autologous platelet rich plasma in order to stimulate meniscal healing.

Abstract: Introduction Meniscal injury treatment that doesn ’ t request operative management is limited and includes physical therapy compression elevation and icing so using of an alternative is justified The use of platelet – rich – plasma ( PRP ) to improve clinical outcome following soft tissue regeneration has been the subject of intense investigation and discussion Goals To present the results of research and advances of PRP activated by AT ( AT ) in reducing size of meniscal lesion and decreasing time of healing Materials and Methods Study is designed to demonstrate achievements in meniscal lesion treatment by use of activated PRP It presents the preliminary results of a pilot project Experimental group includes the meniscal injures which don ’ t request surgical treatment We draw ml of whole blood from which after the processing we obtained platelet – rich – plasma and AT The average count of platelets in PRP was – x baseline Before the application we activated PRP with AT The mL of final product was injected in the knee join space We conducted the clinical and MRI investigation to observe healing process Results Preliminary in RENOVA clinic Belgrade we have done of the planned procedures of preparation and application of activated PRP for meniscal injuries Clinical outcome in treated patients shows shorter time of rehabilitation and MRI have shown the increased healing in treated patients compared to our usual practice Discussion We are considering the possible use of PRP activated with AT as way of stimulation of healing process in meniscal injures that don ’ t require surgical treatment Conclusion The use of activated autologous PRP gives great results in terms of clinical outcomes in patients with meniscal injury The current results of our research which is still in the preliminary phase support this hypothesis.

Download document

Institution: University College London IOMS

Country: United Kingdom

E-mail: wasim.khan@ucl.ac.uk

Title: Variation in differentiation potential in clonal mesenchymal stem cell populations

Abstract: AIMS: Synovial mesenchymal stem cells are a potential source of cells for the repair of articular cartilage defects. Our aim was to identify clonal populations and determine whether they differed in characterisation and differentiation potential. METHODS: Mesenchymal stem cells were isolated from the synovium of patients undergoing total knee arthroplasty and expanded in culture. Six clonal populations were also isolated before initial plating using limiting dilution and expanded. The cells from the mixed parent population and the derived clonal populations were characterised for stem cell surface epitopes, and then cultured in osteogenic medium for 21 days and as cell aggregates in chondrogenic medium for 14 days. Gene expression analyses; glycosoaminoglycan and DNA assays; and immunohistochemical staining were determined to assess chondrogenic responses. RESULTS: Cells from the mixed parent population and the derived clonal populations stained strongly for markers of adult mesenchymal stem cells including CD44, CD90 and CD105, and they were negative for the haematopoietic marker CD34 and for the neural and myogenic marker CD56. A variable number of cells were also positive for the pericyte marker 3G5 both in the mixed parent and clonal populations. The clonal populations exhibited a variable chondrogenic response. CONCLUSIONS: Pericytes are a candidate stem cell in many tissue and our results show that all six clonal populations derived from the heterogenous synovial fat pad population express the pericyte marker 3G5. The variable chondrogenic responses suggest inherent differences between these populations. The chondrogenic potential of the synovium could be optimised by the identification of clonal populations with a propensity to differentiate down particular differentiation pathways.

Download document

Institution: SB Biograd n/m

Country: Croatia

E-mail: josko.jelicic@gmail.com

Title: Does the anterolateral minimally invasive total hip arthroplasty have clinical advantage over classical lateral approach? A prospective three-year follow-up study.

Abstract: INTRODUCTION: The lateral conventional hip approach and the minimally invasive anterolateral (ALMIS) approach are very common in orthopaedic surgery accross Europe. PURPOSE: The main idea of this study was to compare functional clinical outcome of the patients operated by the anterolateral MIS approach (a muscle-sparing technique – modified Watson-Jones approach), and the patients operated by direct lateral approach without the muscle – sparing technique ( conventional – Bauer Hardinge approach ). METHODS : A total of 130 patients were randomly assigned to two groups: 68 in standard method ( STAND ) group and 62 in minimally invasive ( MIS ) group. Hip flexibility, patient mobility, strength of the hip abduction, pain scale, Harris hip score, duration of the hospital stay, and overall satisfaction were measured after seven days, three months, one year, and three years after the surgery. Response rate was 100 % at the first three controls and 63% at the last. RESULTS: At first three follow-ups the statistically significant differences were determined between the groups in hip abduction strength, passive and active hip flexion ability, where MIS group was better in all three follow – ups ( p < 0,05). Patients in MIS group also suffered less pain, used crutches less, stayed in hospital shorter, and were overall more satisfied with the operation outcome . After three years we measured only parameters that were different at previous contols. There were no differences in perceived pain between STAND and MIS group. However MIS group still showed superior strength of the abductor muscles and took shorter time to walk 50m polygon. CONCLUSION: We recommend ALMIS approach for total hip replacement therapy, especially for younger, active population.

Download document

Institution: Centro Hospitalar Tondela Viseu

Country: Portugal

E-mail: joaomorenomorais@gmail.com

Title: Aseptic acetabular component detachment of total hip prosthesis with pelvic discontinuity

Abstract: Introduction: With an aging population, and with the increase in obesity, the number of total hip arthroplasties tends to increase, thereby increasing the number of revisions. The literature shows that the most common causes for total hip arthroplasty revision are, regardless of the component, instability/dislocation and infection. The isolated revision of the acetabulum represents about 12% of all revisions, being the most frequent cause of loosening. Material: We present the case of a 68 years old patient, with a right cemented total hip arthroplasty (THA) placed 16 years ago. Went to the emergency department in December 2011 by history of fall 1 week earlier, referring pain to the right hip during gait. Radiographic study showed acetabular component detachment and possible pelvic discontinuity (Paprosky IIIB). Methods: The patient was operated in April 2012 and was carried out extraction of the acetabular cup and cement and was placed a screwed Kerboull ring with trabecular titanium acetabular cup without surgical complications. Results: A good evolution in the postoperative rehabilitation progra. At 2 months revealed no pain and performed gait with crutches. A year after surgery walks without crutches, without limping and without pain complaints. Radiographic study shows prosthesis unchanged. Discussion: The treatment of the acetabular component of bone defects associated with detachment depends on the characteristics of the patient, the location and degree of defect and the presence or absence of pelvic discontinuity. The ultimate goal of acetabular revision is obtaining a stable fixation and restore the joint center. Conclusion: The objectives of an acetabular component revision are replacing the primary implantation of an acetabular component ensuring functional capacity and lasting symptomatic relief. Regardless of defect found, there is a broad spectrum reconstruction options.

Download document

Institution: OB Slavonski Brod

Country: Croatia

E-mail: hrpitlovic@gmail.com

Title: Patient compliance after total hip arthroplasty

Abstract: The number of total hip arthroplasty carried out in our hospital rising yearly. The aim of out-patient follow up after THA is detection of early failure when revision surgery can be performed more easey and with beter results. Our protocol include review of patient every second year (on alternate years). We performed retrospective review of clinical follow up compliance for 520 patients who undergone total hip arthroplasty from 2002-2009. (FU 5-13 y). Overal compliance was 35%. Patient younger than 60 y, female patients and citizen of town were arthroplasty was performed had better compliance.

Download document

Institution: KBC “Sestre milosrdnice”

Country: Croatia

E-mail: corluka@me.com

Title: Metal – on – ceramic total hip arthroplasty can cause early debris with inflammatory response and pain? – a case report

Abstract: We are presenting 75 year old male patient who developed small particle disease as a result of tissue reaction on metal – on – ceramic type of hip implant. Patient underwent total hip arthroplasty (THA) procedure three years ago with metal – on – ceramic type of implant. Eigth months after initial THA patient had accident and periprostetic fracture was reported with instability of femoral component of implant. Second procedure included replacement of femoral component. Postsurgical procedure and rehabilitation underwent well and patient didn\’t had any complications. Seven months after second procedure patient reported severe pain in left leg, specially in hip region. Range of motion in left hip was reduced and painful and patient was referred to scintigraphy of the left leg. Scintigraphy founded positive accumulation in left hip region so orthopaedic surgeon indicated extraction of existing implant. Intraoperative were found plenty of subacute inflamated fibrosed tissue and biofilm intramedullary while femoral component was extracted. Tissue samples were administered to pathohistological analysis and multiple examples were administered to cell culture analysis and antibiogram. wound was treated with flow drainage for five days. All laboratory findings were negative on microorganism activity, cell culture showed small particle disease as a result of tissue reaction on implant. Two months after extraction of implant, the new THA was performed with metal – on – crosslinked polyetilen type of implant. Postoperative period went without complications, the patient don\’t have pain in left hip region, after rehabilitation range of movements in left hip after second THA are satisfactory.

Download document

Institution: General Hospital Slovenj Gradec

Country: Slovenia

E-mail: ovnicstres@gmail.com

Title: AMIS-What we learned In The Past 7 years

Abstract: Anterior Minimally Invasive Surgery (AMIS) – What We Learned In The Past 7 Years Introduction: Minimally invasive operative approaches for the hip surgery gained a lot of attention in the last decade. Anterior approach is one of them. Objectives: Since May 2007 and until March 2014 in a regional hospital two orthopedic surgeons conducted 148 primary and 1 revision AMIS surgery. The operative technique had to be learned and the learning curve is slow. Are there any differences in operative technique, early postoperative ambulation, limb lengthening after 7 years of experience with AMIS technique? Methods: Retrospectively we analyzed all 149 patients, 47 male and 102 female The following parameters were analyzed: operative blood loss, drainage from operative wound, volume of blood reinfusion by OrthoPAS® system, volume of blood transfusion, duration of surgery, duration of hospitalization, postoperative limb length equality and intra operative and post operative complications. Results: The data showed reduced intra operative blood loss: 736 ml/ patient in 2007 compared to 307,27 ml/patient in 2014. The need for blood transfusion was significantly reduced: 365,71 ml of blood transfusion in 2007 compared to 31,5 ml of blood transfusion per patient in 2014. Duration of surgery (87,77 minutes in 2007 compared to 55,45 minutes in 2014) and duration of hospitalization (12,05 days in 2007 compared to 8,9 days in 2014) were diminished. Postoperative limb length discrepancy was 0,47 cm/patient in 2007 compared to 0,22 cm/ patient in 2014. Conclusion: After learning curve and 7 years of experience with AMIS technique our results shows that the operative blood loss, need for transfusion, duration of operation and hospitalization and postoperative limb length discrepancy were significantly reduced. The main reason to continue with AMIS technique is the preservation of hip musculature and that for significant less postoperative pain, earlier rehabilitation and satisfied patients.

Download document

Institution: Schon Klinik Neustadt

Country: Germany

E-mail: pdufek@schoen-kliniken.de

Title: Ceramic BIOLOX delta in Total Hip Replacement

Abstract: Long term results of THR depend on the tribology of the contact bearing surfaces. The PE wear is the general problem of the hip arthroplasty. We report about our experience with the ceramic articulation in THR. Material: Since 2005 we use in the hip arthroplasty of biologic active patients till age of 70 years the ceramic-ceramic or ceramic-hcl PE articulation. In the period till 2012 we used the combination cer/ cer n: 2734, the combination hclPE/cer n:1950- the combinations 36/36 and 32/32 mm. We measured the clinical results acc. Staffelstein Score in the time of discharge from the rehabilitaion clinic, the number of dislocation prospectively. Results: The best clinical results achieved in the group cer/ cer kombination 36mm- the best range of motion, no dislocation. Complications: Squeaking 5x, malposition of ceramic insert 3x, breakage of the ceramic head 1x. Conclusion: Ceramic Biolox delta insert with combination of ceramic head 36 mm are very stabile, have better range of motion and the risk of long term wear is excluded.

Download document

Institution: Centro Hospitalar de Vila Nova de Gaia Espinho

Country: Portugal

E-mail: tiagocpt@gmail.com

Title: Direct anterior approach

Abstract: The direct anterior approach is an alternative to conventional transmuscular approaches for performing total hip arthroplasty. We present a retrospective study evaluating the results of 60 total hip arthroplasties performed by direct anterior approach, divided into 40 primary hip arthrosis and 20 femoral neck fractures. The mean follow-up in the group of primary arthroses was 15.5 months (6-24 months) and in the group of neck fractures was 14.2 months (7-21 months). There was a significant improvement in the functional evaluation scores between the preoperative and the first postoperative month in the group of primary arthroses, with a slight improvement in the first postoperative month for 6 months postoperatively. In the group of fractures there was a clear improvement in the first postoperative month for 6 months postoperatively. This study confirms the direct anterior approach as a safe procedure for all patients, with precise placement of components and low complication rates. With this intermuscular approach, the patient must recover only for the surgical procedure, but not for the approach itself, which allows early recovery without restriction of movement or loading permission distinct benefit for directly focused outcomes in patients.

Download document

Institution: KBC Zagreb

Country: Croatia

E-mail: ivan.bohacek@gmail.com

Title: How to improve non original acetabular liner stability after revision surgery?

Abstract: Depending on well-defined radiological and clinical criteria, acetabular liner (AL) replacement in cementless hip endoprosthesis is frequently indicated and routinely performed. However, an important issue occurs when cementless acetabular component shows excellent stability and worn liner was discontinued in production during relatively long time span since the primary total hip arthroplasty (THA). Additional problem may occur when stabile cementless acetabular component has diameter smaller than 48 mm and cemented polyethylene acetabular component cannot be implanted into cementless acetabular component because of its size, which exceeds such small diameter. The only solution in those cases is to implant cementless AL with layer of bone cement underneath. Here, we present two patients who underwent primary THA without any complications. After 19 years – Pt1 and 10 years – Pt2; AL became worn and replacement was indicated. Intraoperatively, in both patients acetabular components showed excelent stability, while original AL were discontinued in production. Since acetabular components were too small, use of cemented polyetylene acetabular component couldn\’t be cemented into cementless acetabular component. Therefore, cementless AL was used instead, with layer of cement underneath. In Pt2 1 year after, liner got detached from layer of cement, while in Pt1 liner became worn after 4 years, without signs of instability. Second liner replacement was performed in both patients, this time with roughening of the convex side of the cementless acetabular liner in order to prevent liner detachment and luxation. Currently, there are no complications present in those patients. According to our experience, we may conclude that in complex cases when original liner is not available and acetabular component is too small for cemented acetabulum to be implanted, cementless acetabular liner can be implanted with convex side roughened in order to provide adequate stability and prevent AL slippage and luxation.

Download document

Institution: KBC Zagreb

Country: Croatia

E-mail: domagoj.delimar@kbc-zagreb.hr

Title: Advantages of the modified cotyloplasty technique in dysplastic hip arthroplasty – results of 5 year follow up

Abstract: PURPOSE: Our modification of cotyloplasty technique consists of acetabular reaming up to the medial wall, subsequent controlled fracture of the medial wall and stabile acetabular component fixation with superolateral screws. Our technique does not require any grafting technique of the acetabular bottom. METHODS: We prospectively analyzed 21 THA in patients with hip dysplasia and insufficient bone stock at the level of the true acetabular roof. In all patients modified cotyloplasty technique was performed. RESULTS: Patient’s average age at the time of surgery was 53.4±10.3 years and average follow up was 5.7±2.3 years. Average acetabular size was 48, acetabular angle was 41.3°±8.5°, acetabular anteversion was 17.5°±6.0°, cup medialization was 6.6±2.9 mm in average. In average 46±20% of the total acetabular surface was protruding in the pelvis. In 4 cases superolateral acetabulum was not completely covered with bone (lateral cup placement was 6.5±3.7 mm in average). In one case (medialization of 9.6mm) primary instability occurred and cup was replaced with another cementless cup and generous spongioplasty of the acetabular bottom. CONCLUSION: Cotyloplasty is used in cases of insufficient bone stock at the level of true acetabular roof. It removes necessity to use any augmentation of the acetabular roof. It seems that primary stability can be achieved with as low as 25% of contact area between the bone and acetabulum (since when even 77% of the acetabulum protrudes in the pelvis, good primary stability is achieved). Preserved medial lamina and periosteum heal and thus provide secondary (long lasting) cup stability.

Download document

Institution: KBC Zagreb

Country: Croatia

E-mail: gbic@mef.hr

Title: Modified lateral approach in dysplastic hip arthroplasty

Abstract: PURPOSE: We present a modification of the direct lateral approach to the hip that provides excellent exposure to both, femur and acetabulum. Such approach allows adequate shortening of the proximal femur and further leg length equalization in dysplastic hip without necessity for trochanteric osteotomies, transverse cuts or detachment of abductor muscles. METHODS: Two groups of patients with dysplastic hips were compared: a) test group – Crowe 3 and 4 patients, which underwent THA using modified lateral approach; and b) control group – Crowe 1 and 2 patients which underwent THA using direct lateral approach. ROM, strength and balance board testing together with general functional assessment scores were examined before surgery and 6 months after surgery. RESULTS: ROM, strength and balance board testing were significantly improved postoperatively in both, test and control groups. There was no significant difference between the groups, except in some specific (combined) motions: reduced flexion and internal rotation in test group; and reduced extension, abduction, and external rotation in control group. General functional assessment scores demonstrated significant improvement after surgery in both groups, while there was no significant difference between the groups. CONCLUSION: We may conclude that the use of modified lateral approach in patients with Crowe 3 and 4 dysplastic hips allows equal functional result compared to Crowe 1 and 2 patients that underwent same procedure with use of standard approach. Therefore, we recommend the use of modified lateral approach in patients with severe hip dysplasia undergoing THA.

Download document

Institution: General Hospital Jesenice

Country: Slovenia

E-mail: tomaz.silvester@sb-je.si

Title: Enhanced Recovery After Surgery (ERAS) Protocol in Total Joint Arthroplasty

Abstract: Introduction As the general population is ageing there is growing number of total joint arthroplasty procedures for degenerative joint diseases On the other hand the financial resources for healthcare budgets are limited or even shrinking The ERAS protocol can decrease patients \’ in hospital length of stay ( LOS ) without compromising quality of treatment thus being beneficial for patients as well as for hospital budget We investigated whether the goals of implementation of ERAS protocol were achieved at normal ( general ), not specialized orthopedic department in regional hospital Materials and Methods All patients to whom primary total hip or knee arthroplasty was performed in year were included in this study Patients were divided in two groups with regard to implementation of ERAS protocol in Group there were patients operated on before implementation ( patients ) and in Group patients treated according to ERAS ( patients ). The analyzed outcome measures were in hospital LOS and readmissions in first days after discharge Results A total of patients were included in the study of them went through \” normal \” clinical treatment whereas patients were treated according to enhanced recovery protocol Both groups were comparable with regard to age gender and comorbidities distribution Mean LOS in Group was days and was significantly shorter than in Group ( days ). On the other hand there were no signifcant differences in readmission rate in first days after operation Discussion The enhanced recovery protocol was successfully and effectively implemented at our department with LOS significantly reduced without increased mortality This was achieved with several multidisciplinary organizational changes before and during hospitalization with peri and postoperative optimization of blood management ( regular use of tranexamic acid ) and pain control ( multimodal opioid sparing local infiltration analgesia ), and especially with optimization in physiotherapy

Download document

Institution: Institute of Orthopedics, physical medicine and rehabilitation Dr. Miroslav Zotović

Country: BiH

E-mail: slavko.manojlovic@gmail.com

Title: Lateral approach in primary TKR

Abstract: Introduction: In valgus deformity of the knee with angulation more than 10 ° there is a stretch of medial soft tissue structures (primarily MCL) and moderate or severe hypoplasia of the lateral condyle. In addition, there is a certain degree of lateralization of the patella, external rotation of the tibia, and internal rotation of the femur. Objectives: To present the advantages of the lateral approach in TKR due to degenerative knee osteoarthrosis associated with knee valgus angulation more than 10°, and with patellar dislocation or subluxation. Materials and methods: The work included 41 patients (32 women, 9 men) who underwent surgery in IOPMR \”Dr M.Zotovic\” during period May 2008 – December 2014. Surgical technique involved a lateral approach to the knee joint, which will be described in detail. Patients received standard antibiotic and thromboembolic prophylaxis, and they were included in the program of early rehabilitation with full bearing allowed on the operated leg first postoperative day. All patients were followed radiologically and functionally (HHS, Womac index). Results: The approach itself performes a release and balance and this improves the stability and patellar tracking. In all patients we achieved the restitution of the lower extremity axis. We have not noted avascular necrosis of the patella, which is described in the literature as the most common complication with this approach. Conclusions: The lateral approach because of its advantages is the technique of choice in TKR in gonarthrosis with valgus angulation of the knee of more than 10 degrees.

Download document

Institution: KBC Osijek

Country: Croatia

E-mail: boriszulj@yahoo.com

Title: Bone loss management in difficult primary and revision total knee surgery

Abstract: Thanks to great functional results and survivorship rate there is great increase in total knee surgery arround the world during past two decades. Now we are facing growing number of knees that has to be revised as a result of loosening, implant failure or infection. Total knee revisions are becoming more and more almost everyday procedure with lots of challenges to overcome as a result of bone loss and patient\’s expectations to have rully functional and painless knee. Bone loss mangement is also often issue in primary total knee implanting especially when we are dealing with patients with rheumatoid arthritis or posttraumatic osteoarthritis. The goal of this presentation is to show difficoult cases and examples and educate how can we deal with bone loss using modern revision implants from our own expirience.

Download document

Institution: KBC “Sestre milosrdnice”

Country: Croatia

E-mail: jakov.prenc@gmail.com

Title: Epidemiological data of rehabilitation after total knee arthroplasty

Abstract: The main objective of this paper is to analyze the effect of rehabilitation in recovery after postoperatively the way to determine the difference in the clinical-functional tests of the knee joint. We will try to prove that we can do better outcome results by our on-line instructions for rehabilitation through recorded video material where every patient is on their own at their own home. The SF-36 is a multiapplicable health status questionnaire with 36 questions. These are questions with multiple choice answers. The SF-36 is a theoretically based and empirically proven operationalization of two general concept of health-physical health and mental health and their two general events: the functioning and well-being. The study included 30 patients who were treated according to the same protocol, which consisted of preoperative preparation, surgery and post-operative rehabilitation in hospital and spa. The scientific contribution of this research is significant for clinical orthopedic practice. This study evaluated a completely new approach and the use of new platforms for part of the recovery process in which patients are mostly left to themselves and the organization of rehabilitation, which does not always follow their needs. With the help of this method, we could communicate to patient daily in the early stages of recovery important messages to the possibility of performing kineziotherapy through the video instructions which could shorten the postoperative period of rehabilitation and improve clinical outcomes.

Download document

Institution: University Children’s Hospital

Country: Serbia

E-mail: bojanbukva@yahoo.com

Title: Minimal invasive surgery in treatment of flexibile flatfoot in children

Abstract: Aim of this study is to evaluate the results in treatment of the flexibile flatfoot in children using the technique of an extraarticular arthrodesis with the cannulated screw after failed conservative treatment. Method: Thirthy feet in 17 children were included in this study during 6 years period. The average age was 10.5 years (8-15). There were 9 girls and 8 boys. We performed the same technique for each patient under the X ray fluoroscopy. The radiographic parameters were investigated before and after the surgical treatment. The talo-calcanear (TC), talo-navicular (TN), talo-first metatarsal bone (T1MT) and calcanear pitch (CP) angle were measured, in anteroposterior and (or) profile view. We compared the result before and after the surgery. Results: After the surgical treatment the radiographic parameters were not significantly changed but the clinical parameters were singnificantly improved.A degree of extension and eversion of the foot were remarkably reduced withouth desturbing other motions in talocrural and subtalat joint. Conclusion: Extraarticular arthodesis using cannulated screw as a method of minimal invasive surgery represents a method of choice in treatment flexibile flatfoot in children. Key words: flexibile flatfoot, extraarticular arthrodesis, children.

Download document

Institution: University Children’s Hospital

Country: Serbia

E-mail: bojanbukva@yahoo.com

Title: Combination of intramedullary alignment and Ilizarov external fixator in treatment of leg length discrepancies in children

Abstract: Background The purpose of this study was to evaluate the influence of the intramedullary aligment with Kirschner ( K ) or Titanium Elastic ( TE ) wires combined with an Ilizarov external fixator ( IEF ) on the healing index lengthening index duration of hospital treatment and complications in congenital and acquired leg discrepancy Methods This study included paediatric patients aged – years during years period We compare the healing index ( HI ), lengthening index ( LI ), duration of hospital treatment and complications between two groups of children The first group of children undergoing limb lengthening by the IEF alone ( group I ). The other group ( group II ) was treated with the combination of the IEF and intramedullary stabilization using two K – wires or TE – wires Also we compare all of following parameters depending of the type of intramedullary alignment ( K or TE wires ). Results We found significant differences between Group I and Group II in the duration of external fixator application ( p < ), HI ( p < ) and duration of hospitalization ( p < ). Concerning leg length inequality ( LLI ) and LI we found no significant differences between two groups of patients Also we found no significant differences in complication occurrence and etiology of LLI ( congenital or acquired ) between two groups of patients Depending of the type of intramedullary alignment we found less complications and shorter period of intrahospital treatment in patients treated using in combination of IEF and TE wires Conclusion The intramedullary alignment has multiple advantages as a method of treatment of the limb discrepancy The major effect of the application of the combination of external circular fixation and intramedullary alignment is significant decrease of external osteosynthesis duration and healing process

Download document

Institution: Frimley Park Hospital

Country: United Kingdom

E-mail: patalmela@gmail.com

Title: Imaging in Congenital Hip Dysplasia

Abstract: Introduction: Developmental dysplasia of the hip (DDH) is a significant cause of disability in children. Ultrasonography (US) is the preferred modality for evaluating the hip in aged 6 months or younger. Graf angles represent the osseous coverage of the femoral head and its measurement facilitates grading of the condition. Plain pelvic radiographs are the primary imaging modality at 4-6 months after the femoral head begins to ossify. Objectives: Evaluate the standard of care of an Orthopaedic department in a District General Hospital in diagnosis and management of children DDH using combined radiological modalities. Methods: A literature review regarding diagnosis and management of DDH was performed. All DDH patients referred to a District General Hospital, during the period 2005-2010 were reviewed and analysed regarding: demographics, age at referral and discharge, and radiology reports. Results: 113 patients (16 males, 97 females) were followed up, 76% of the cases were unilateral and 34% bilateral. Mean age of first scan was 3 months and follow-up average was 1 year and 3 months. 80% patients were discharged following a report establishing no joint abnormality and 9% were discharged with a minimally shallow acetabulum unilaterally The mean number of scans for each patient was 5. 13% presented with DDH over 4 months of age and 7.5% over 1 year of age. 11% assessed with plain X-ray.47% of patients had Graf angles calculated and documented in one or more US reports. Conclusions: There is a need to establish an agreed imaging pathway for DDH that accurately monitors progression of the condition. The absence of a guideline produces inconsistency in follow up and potentially unnecessary treatment.

Download document

Institution: Klinika za dječje bolesti Zagreb

Country: Croatia

E-mail: tomislav.ribicic@optinet.hr

Title: Extra articular hip impingement after rectus femoris muscle avulsion

Abstract: The anterior inferior iliac spine avulsion fracture occures by the pull of the rectus femoris muscle. An apophyseal avulsion injury is seen most often in adolescents during sports activity involving kicking, due to eccentric contraction of the rectus femoris as hip extends and knee is flexed which causes avulsion of its anatomic origin of the pelvis. In some instances exostosis formation after an avulsion fracture of the anterior inferior iliac spine is observed and it can be quite extensive. Treatment of such type of impingement is open or arthroscopic decompression. We present two cases of teenage boys with a hip impingement due to rectus femoris muscle avulsion during sports activity. A fourteen-year-old boy developed complaints of pain and swelling in projection of the left anterior superior iliac spine. Few months later he noticed a firm bump on the same place. Clinical investigation showed significant flexion and internal rotation deficit of the left hip. The CT showed a large bony exostosis measuring 5×3,5cm arising from anterior inferior iliac spine towards the hip joint. An exostosis ablation was performed with the rectus femoris muscle origin transosseal reconstruction. One year later the boy developed the same symptoms and a new exostosis was found on the same place. There wasn’t history of a new trauma. Another ablation was performed and the muscle origin was attached to the tensor fasciae latae muscle rather than another rectus femoris muscle origin reconstruction. After the second operation the boy had no symptoms. A seventeen – year – old boy had the similar problems on the right side. Simple exostsis ablation was performed and the boy was symptoms free.

Download document

Institution: Klinika za dječje bolesti Zagreb

Country: Croatia

E-mail: tomislav.ribicic@optinet.hr

Title: Operative solutions for trublesome tumor localisations in children and adolescents

Abstract: For the last three years in the department of pediatric orthopedics of Children’s hospital Zagreb we have performed complicated operative procedures treating malignant skeletal tumors in children and adolescents. The aim of this work is to show our experience in solving difficult problems of reconstruction after resection of a tumor in troublesome localization. We operated five teenage boys with diagnosis of pelvic Ewing sarcoma and one boy with the distal humeral osteosarcoma. Pelvic “en bloc” resections were followed by either 3D custom made implant or 3D custom made bone cement spacer and total hip arthroplasty. A custom made elbow endoprosthesis was built in after “en bloc” resection of the osteosarcoma of the distal humerus . Special problem is a reconstruction of the upper extremity in small children since the metal implant is too heavy for them. A resected part of the proximal humerus in a 4-year-old boy was temporary replaced by a bone cement spacer, and the arm function is surprisingly good. However the results mostly depend on tumor disease biology. Metal implants enable good reconstruction and extremity function unlike most of the cement spacers which primary serve temporary as space keepers until the metal implant is built in.

Download document

Institution: Klinika za dječje bolesti Zagreb

Country: Croatia

E-mail: marijana.simic81@gmail.com

Title: Our experience in usage of lcp pediatric hip plate for varus femoral corrective osteotomy

Abstract: There are many indications in pediatric orthopedics for performing a proximal femur varus osteotomy. The aim of this report is to show our experiences in usage of the LCP Pediatric Hip Plate for various indications requiring a femoral varus osteotomy. Last year we operated 10 children, 7 girls and 3 boys, aged form 3 to 14 using different sizes of LCP Pediatric Hip Plate. Indications were Legg-Calve-Perthes disease, sequels of septic arthritis and valgus deformity due to cerebral palsy and developmental hip disorder. The operative procedures took from 45 to 90 minutes, they were performed in general anesthesia and we had no complications. Our short experience in using LCP Pediatric Hip Plate is positive. The plate enables very good correction control and stability with less technical problems in comparison to the blade plate.

Download document

Institution: Klinika za dječje bolesti Zagreb

Country: Croatia

E-mail: marijana.simic81@gmail.com

Title: Epithelioid sarcoma rare soft tissue tumor presenting as finger wound that doesn’t heal

Abstract: Epithelioid sarcoma is a rare soft tissue sarcoma in young adults, mostly men, involving the upper extremities 60% of the time and it is often confused with a variety of malignant and benign conditions. It most frequently affects hands and forearms followed by distal lower extremities and proximal upper extremities. Most tumors present as firm-to-hard palpable masses, either in the deep soft tissue or in the dermis. Often the superficial lesions will ulcerate, causing a mistaken diagnosis of a poorly healing traumatic wound or wart. It has a tendency for lymph node metastasis. Five year survival and ten year survival rate for patients with epithelioid sarcoma are approximately 50-70% and 42-55% respectively. Gender, site, age of diagnosis, tumor size and microscopic pathology have been shown to affect prognosis. We present a rare case of the epithelioid sarcoma of the index finger in a thirteen-year-old girl. The sarcoma presented first as an ulceration of the finger tip and was treated as an infection. Otherwise the girl was healthy but the wound didn’t heal so the sample for histopathology was taken, and the diagnosis was fibrous histiocytoma. The ulcer was progressing and the amputation of the distal phalanx was performed. Histopathology diagnosis was epithelioid sarcoma. The girl was then referred to our hospital for chemotherapy and was well for about a year. After that time, the same finger became painful, swollen with a new ulceration. Axillar lymph nodes on the same side were enlarged so the fine needle aspiration was performed for the cytology which found the cells of the epithelioid sarcoma in the specimen. We exarticulated the finger in the metacarpophalangeal joint, after which followed a chemotherapy.

Download document

Institution: Klinika za dječje bolesti Zagreb

Country: Croatia

E-mail: marijana.simic81@gmail.com

Title: Distal phalanx of the finger unusual localisation of the osteoid osteoma

Abstract: Osteoid osteomas of the distal phalanx of fingers are uncommon so the diagnosis is often delayed for several months to years. An eleven-year-old girl has complained of an occasional pain of the fifth finger tip of the hand for the last three years. The pain was more expressed at night and on direct palpation, without relief on ibuprofen. There was no history of trauma and infection. The nail surface was enlarged, without other changes. Radiographs were normal, MR investigation showed only soft tissue edema so she was treated with local corticosteroid injections and indomethacin tablets by a rheumatologist. Still there wasn’t improvement about the symptoms, moreover, the nail seemed to be even more enlarged so she was referred to out hospital. We arranged a new MR which showed three millimeter oval structure on the dorsal aspect of the distal phalanx. We removed it and sent it to a histopathology analysis, the diagnosis was osteoid osteoma. After the operation, the girl was finally pain free. A better awareness of this tumor may prevent unwanted delays in diagnosis.

Download document

Institution: University Children’s Hospital of both Basel

Country: Switzerland

E-mail: uli_Lenze@web.de

Title: Injectable bone substitutes for the minimally invasive treatment of simple bone cysts a

Abstract: Background: Fracture risk of simple bone cysts in children and adolescents is mainly related to the size and activity of the cyst. The latter can be quantified preoperatively using the cyst-index whereas various different treatment techniques are described. The aim of this study was to evaluate the results after percutaneous cyst aspiration, hydrogen peroxide lavage and injection of synthetic tricalcium phosphate. Methods: In total 21 patients (13.2 ±3 years) with 21 simple bone cysts (5 femura, 11 humeri, 5 calca-nei) and 27 treatments between 2006 and 2011 were included. All patients were treated with the same minimally invasive technique. At the femur, depending on size and location of the cysts, an additional internal fixation was performed prior to injection. 13 patients presented with preceding fractures. Results were evaluated with regard to (re-)fracture, radiological healing, activity level, relapse and functional outcome. The mean follow-up was 40 ±19.6 months. Results: We observed partial or complete radiological response in 81% of patients after a mean of 13 ±3.4 months. Unrestricted activity was reached in 95% of patients 1,5 months postoperatively. In total 1 refracture (femur) and 2 (7%) wound infections were recorded. 5 patients (28%) required a second injection after 21 ±4.6 months whereas 3 showed healing 12 ±0.3 months later. Only 1 patient required a third injection with healing after 13 months. Conclusion: This minimally invasive technique appears to be a usefull treatment option for active simple bone cyst in children and adolescents. Especially at the upper extremity as well as the calca-neus a proper primary mechanical stability can be achieved in order to avoid (re-)fractures. However, at the proximal femur additional stabilisation by means of elastic intramedullary nails is strongly recommended.

Download document

Institution: KBC “Sestre milosrdnice”

Country: Croatia

E-mail: mstrle@yahoo.com

Title: Konzervativno liječenje humeroskapularne luksacije

Abstract: Uvijek u slučaju dislokacija (iščašenja), nastaje jaka sila koja vuče rame prema van ili dolazi do ekstremne rotacije zgloba koja izbacuje glavu humerusa izležišta na lopatici. Ukoliko se ruka naglo i snažno povuče prema nazad mišići su nespremni na akciju ili je sila prevelika isto tako dolazi do dislokacije. Cilj rada je kroz praćenje broja pacijenata u Klinici za traumatologiju prikazati koliko pacijenata je zaprimljeno u Kliniku sa dijagnozom humeroskapularne luksacije povezanost povrede sa dobi i spolom pacijenta koliko je prosječno trajanje liječenja i oporavka koje su najčešće komplikacije koje se javljaju kod konzervativnog liječenja te omjere konzervativnog i operativnog liječenja. Naravno i sama prevencija i smanjenje broja povreda unapređenje metoda konzervativnih postupaka. Koristi se statistička obrada podataka dobivena iz baze podataka Klinike iz koje će se dobiti potrebni podaci. Istraživanje će obuhvatiti razdoblje od mjeseca točnije siječanj srpanj kolovoz te prosinac godine kroz koje će biti obuhvaćeno pacijenata Intervancije medicinske sestre odnosno tehničara započinju već prilikom samog dolaska pacijenta u hitnu ambulantu gdje se pacijent zbrinjava za daljnje pretrage. Svoja znanja i vještine medicinska sestra tehničar nastavlja koristiti kroz daljnju obradu pacijenta bilo to daljnje konzervativno liječenje ili sama briga za takvog bolničkog pacijenta.

Download document

Institution: KBC “Sestre milosrdnice”

Country: Croatia

E-mail: nevenka.lukavski@kbcsm.hr

Title: Upotreba personaliziranog 3D implantata u rekonstruktivnoj kirurgiji zdjelice

Abstract: Uvod Razvoj tehnologije, kirurških tehnika i instrumentarija, doveo je do novih terapeutskih mogućnosti u liječenju do sad neizlječivih i mutilirajućih oboljenja. Bit će prikazan slučaj 62 – godišnjakinje s hondrosarkomom zdjelice čiji bi jedini dosadašnji način liječenja bio hemipelvektomija te novi primijenjeni način liječenja upotrebom rekonstruktivnog, personaliziranog 3 – D implantata. Metode Osnova za izradu implantata je 3 – D model zdjelice učinjen MSCT-om. Potom se računalno potpomognutim dizajnom pristupa zamijeni tumorom zahvaćenog tkiva i dobija se elektronski nadomjesni model dijela zdjelice. Daljnjim testiranjima istog na sile koje trpi zdjelica u svakodnevnom životu, konstrukcijom nosača i zidova zdjelice, acetabula , dobije se definitivni elektronski model koji ide u „ispis“ pri čemu je glavni gradivni materijal titanij. Tako dobijeni model se tretira po pravilima asepse i spreman je za ugradnju u ljudsko tijelo. Rezultati Slijedeći korak je priprema izabranog bolesnika i operacijsko liječenje, pri čemu je bitno da svaki član tima bude dobro pripremljen za svaku etapu operacijskog liječenja. Pri tome operacijska sestra mora biti visoko koncentrirana pri svakoj etapi liječenja s obzirom da se radi o kompleksnoj operaciji visokog rizika. Po završetku operacijskog liječenja pristupa se potpornoj terapiji i regularnoj rehabilitaciji. Zaključak Računalno potpomognuti modeli imaju svoju primjenu u kirurgiji budućnosti pri rješavanju kompleksnih traumatoloških i ortopedskih te tumorskih stanja.

Download document

Institution: KBC “Sestre milosrdnice”

Country: Croatia

E-mail: margareta.bajsic@yahoo.com

Title: Algoritmi zbrinjavanja ozljeđenika s prijelomom zdjelice

Abstract: Prijelomi zdjelice su indikator teske traume. Ispravno rana postavljena dijagnoza najvaznija je za plan lijecenja i daljnju opservaciju ozljedjenika. Medicinska sestra kao strucan dio tima sudjeluje u intervenciji i lijecenju od samog dolaska ozljedjenika u zdravstvenu ustanovu. Pretpostavka je da poznavajuci algoritam zbrinjavanja ozljedjenika s prijelomom zdjelice znaci najbolju mogucu dijagnozu, lijecnje i skrb za ozljedjenika. Cilj mora biti skrb bolesnika izvedena na ucinkovit, primjeren i ekonomski prihvatljiv nacin. Pri izradi rada koristena je anketa, bazirana na „Likertovoj ljestvici“, usmjerena na analizu teoretskog prepoznavanja tezine ozljede kod ozljedjenika s traumom zdjelice te mjesta i nacina hitnog zbrinjavanja takvih ozljeda u Klinici za traumatologiju, KBC Sestre milosrdnice. Vecina ispitanika svjesna je tezine ozljede zdjelice i kakve konsekvence ona potencijalno nosi sa sobom. Vecina ima spoznaju o tome kako soba za hitni primitak mora izgledati, odnosno s kakvim lijekovima i aparatima mora biti opremljena. Nadalje, polovican postotak ispitanika je upoznat s algoritmom zbrinjavanja ozljede zdjelice i u mogucnosti su adekvatno komplementarno djelovati u timskom zbrinjavanju ozljeda, a svi su svjesni potrebe za osnovnom i trajnom edukacijom vezanom uz hitno zbrinjavanje ozljeda zdjelice. Intervencije medicinkse sestre pri hitnom zbrinjavanju teskih ozljedjenika s ozljedom zdjelice usko je vezana uz lijecnicki posao te u isto vrijeme ima specificnosti kojima svaka medicinska sestra koja ima doticaja s takvim ozljedjenicima mora vladati. U pozadini svega stoji teoretsko poznavanje zbrinjavanja teskih ozljedjenika kako bi se to znanje uspjesno primijenilo u konkretnim slucajevima. Medicinska sestra kao dio zdarvstvenog tima koji pruza pomoc ozljedjeniku s ozljedom zdjelice potrebna je trajna edukacija vezana uz posao koji obavlja. Za samog ozljedjenika to predstavlja bolje shvacanje svojeg zdravstvenog stanja i potencijalnih rezultata lijecenja, vracanje optimizma te na kraju znatno uspjesniji i kraci boravak u zdravstvenoj ustanovi. Kljucne rijeci: medicinska sestra, ozljeda zdjelice, suradnja zdravstvenog tima, edukacija.

Download document

Institution: KBC “Sestre milosrdnice”

Country: Croatia

E-mail: david.elvis@gmail.com

Title: Konzervativno liječenje prijeloma distalnog radijusa

Abstract: Prijelom podlaktice osobito palčane kosti jedan je od najčešćih prijeloma starije životne dobi Ručni zglob jedan je od vjerojatno najkompliciranijih zglobova ljudskog tijela zbog svoje anatomske specifičnosti i velikog broja zglobova koji ga čine kao cjelinu Podlaktica i ručni zglob su u funkciji gornjeg ekstremiteta i tijekom svakodnevnih aktivnosti su od velike važnosti to nalaže veliku pozornost pri zbrinjavanju njihovih ozljeda U starijoj životnoj dobi većina prijeloma nastaje u žena i uvjetovani su slabijom osteoporotičnom kosti što dodatno otežava liječenje Cilj rada je kroz praćenje broja ozljeđenika u Klinici za traumatologiju KBC Sestre milosrdnice kroz dva uzastopna mjeseca pobliže prikazati koliko je zaprimljeno ozljeđenika s ozljedom prijeloma distalnog radijusa koja im je prosječna životna dob najčešće komplikacije koje se javljaju kod konzervativnog liječenja i omjer konzervativnog i operativnog liječenja Usporedbom smjernica liječenja i algortima u Klinici za tramatologiju KBC Sestre milosrdnice i u zapadnim državama dobit ćemo uvid u duljinu trajanje liječenja i rehabilitacije ozljeđenika i odnos osteoporoze i prijeloma palčane kosti Obradom podataka istraživanja dobivene iz bolničkog informatičkog sustava ( BIS – a ) dobit ćemo uvid u broj ozljeđenika s ovom ozljedom procjenu razine kvalitete dobivenih usluga za vrijeme liječenja specifikacija usluga te evaluaciju uspjeha liječenja prijeloma i funkcije ručnog zgloba nakon liječenja u Klinici za traumatologiju KBC Sestre milosrdnice

Download document

Institution: KBC “Sestre milosrdnice”

Country: Croatia

E-mail: z.martic29@gmail.com

Title: Multidisciplinarni pristup pacijentu s prijelomom uslijed opekline

Abstract: Opekline kože potkožnog tkiva i mišića obuhvaćaju širok raspon različitih traumatskih struktura organa i organskih sustava pri čemu nastaju brojne komplikacije po ž ivot opasne za samog ozljeđenika Tijekom godine u KBC Sestre milosordnice Zavodu za opekline Kinike za traumatologiju hospitalizirano je pacijenta od č ega pacijenta s pridu ž enim ozljedama lokomotrnog sustava Cilj rada je predo č iti pravilnu hitnu obradu pacijenta s opeklinskim ozljedama kože i lokomotornog sustava terapijskim metoda te mogućim komplikacije tijekom liječenja Pacijentica N V zaprima se kao dogovoreni premještaj iz OB Požega koja je prilikom obavljanja kućanskih poslova s vrelom vodom zadobilaotvoreni prijelom desne potkoljenice sopeklinama i stupnja gornjih i donjih ekstemiteta trupa i spolovila Pri samom primitku pacijentica je pri svijesti kontaktibilan GCS respiratorno suficijentan urednih vitalnih funkcija Učinjena je obrada opeklinksihrana te uz nadzor anesteziologa u činjanja je repozicija prijeloma u području desnog gležnja Nakon dva dana učinjen operativni zahvat u OETA Plasiran vanjski fiksator po Ilizarovu na desni gležanju činjena je nekrektomija u području desnog gležnja uzet bioptat tkiva za MKB Postoperativno bolesnica budna spontanog suficijentnog disanja upućena u opeklinskiJIL U opeklinskom JIL – u kontinuiranimonitoring vitalnih funkcija praćenje satne diureze primjena ordinirane terapije kontrola ordiniranih laboratorijskih nalaza Liječenje opekline provedeno operativno u nekoliko navrata učinjena je nekrektomija i pokrivanje defekata kože vlastitim slobodnim kožnim presatkom po Tierschu – Mash graft tehnikom i Micrografting Tretiranje operiranih rana se vrši svakodnevno uz poštivanje mjera asepse i antisepse

Download document

Institution: Klinika za dječje bolesti Zagreb

Country: Croatia

E-mail: marita.anzulovic@gmail.com

Title: Sestrinska skrb bolesnika sa Ewingovim sarkomom nakon operativne

Abstract: Najčešći maligni tumori kosti u djece i adolescenata su osteosarkom i Ewing sarkom. Ewing sarkom najčešće se javlja u srednjem dijelu dugih kostiju nogu i ruku, ali se također može razviti u zdjelici i drugim kostima. Bolesnici s ovim tumorima zahtijevaju multidisciplinarnu skrb tima koji uključuje dječjeg onkologa, ortopedsko onkoloških operatera, fizikalnu terapiju, patologa i radiologa te medicinske sestre specijalizirane za njegu ovakvih bolesnika. Kombinacija poboljšanja novih tehnika za kirurško uklanjanje tih tumora i unapređenje postupka za funkcionalnu obnovu sada omogućuje da 90-95% pacijenata s agresivnim tumorima se mogu liječiti, bez potrebe za amputacijom. Korištenje novih limb-sparing tehnika u zbrnjavanju bolesnika sa Ewing sarkomom provodi se i na našem odjelu što predstavlja izazov za cijeli tim sa posebnim naglaskom na sestrinsku skrb. Medicinske sestre imaju priliku pomoći pacijentima u pronalaženju odgovarajuće psihosocijalne podrške u preoperativnom periodu, dok u postoperativnom periodu fokus je na managementu boli i nuspojavama liječenja te pružanju djetetu i roditeljima podrške da tim čini sve što može kako bi optimizirao kvalitetu života. Cilj ovog rada je prikazati sestrinske postupke kroz prikaz slučaja bolesnika J.D. 16 god. sa dijagnozom Ewing sarkom zdjelice. Primljen je na odjel dječje ortopedije sa jedinice intenzivnog liječenja nakon zahtjevnog operativnog zahvata rekonstrukcije zdjelice i gornjeg dijela femura.(limb-sparing tehnika) Ključne riječi: Sestrinska skrb, Ewing sarkom,limb-sparing tehnika

Download document

Institution: OB Koprivnica

Country: Croatia

E-mail: zeljkavondracek@gmail.com

Title: Sestrinske intervencije kod ugradnje intramedularne fiksacije Supernail

Abstract: AO metoda, kao opće prihvaćena metoda liječenja koštanih prijeloma prvi se puta spominje 1958. god. u Švicarskoj. Razvoj tehnologije uvelike je pridonio u izradi implantanata, boljem poznavanju biomehanike, funkciji i oblik normalnog i patološki promijenjenog sustava za kretanju po zakonu statike i dinamike. Napredak kirurških tehnika, aseptički i antiseptički postupci, upotreba antibiotika te razvoj anesteziologije doveli su do velikog napretka na području traumatologije. Cilj ovoga rada je prikazati standardizirane postupke kod uvođenja intramedularne fiksacije pomoću RTG pojačivača, s naglaskom na sigurnost pacijenta od ulaska u operacijski blok, do završetka operacijskog zahvata i izlaska pacijenta iz operacijskog bloka. Rad cijelog zdravstvenog tima uvelike pridonosi kvaliteti izvođenja samog zahvata. Medicinska sestra kao jedna od članova tima svojim znanjem, vještinam i profesionalnošću tijekom cijelog operativnog zahvata, ali prije i post operativnoj zdravstvenoj skrbi pridnosi poboljšanju i što ranijem oporavku bolesnika. U Općoj bolnici Koprivnica prvi takav zahvat izveden je 2005. godine i od tada do danas provodi se po protokolu usvojenom od strane Jedinice za kvalitetu.

Download document

Institution: KB Dubrava

Country: Croatia

E-mail: kozinablazenka@gmail.com

Title: Stručnost, učinkovita komunikacija i timski rad u operacijskoj dvorani

Abstract: Stručnost, učinkovita komunikacija i timski rad u operacijskoj dvorani Expertise, effective communication and teamwork in the operating room Operacijska dvorana je mjesto koje zahtijeva timski rad, učinkovitu komunikaciju, brzo donošenje odluka, rutinske provjere, provođenje operacijske zdravstvene njege, pridržavanje protokola te ispravno vođenje sestrinske dokumentacije. Priprema bolesnika, promišljeno pozicioniranje, pravilno rukovanje opremom samo su neki od čimbenika važnih za sigurnost pacijenata u operacijskoj dvorani. Ako se izvode pravilno mogu se spriječiti neželjeni događaji u operacijskoj dvorani. Operacijska sestra/tehničar, kirurg i članovi anesteziološkog tima odgovorni su za pravilan položaj tijela pacijenta tijekom operacijskog zahvata. Prije operacije potrebno je uzeti u obzir i faktore rizika kao što su npr.duljina postupka, operacijski položaj, dob, stanje kože, mobilnost itd. Bazični položaji u operaciji su supinacijski, pronacijski, lateralni i litotomijski. Svaki od njih nosi određene rizike za komplikacije odnosno za neželjeni događaj koji se mora pravilno dokumentirati i prijaviti. Provođenjem kontinuirane edukacije osoblja u operacijskoj dvorani razvija se svijest o potencijalnim komplikacijama te unapređuje sigurnost i zaštita pacijenta tijekom operacijskog zahvata. Sprječavanje medicinske pogreške, obrazovanje i sigurnost čine poboljšanje u zdravstvenom sustavu koji djeluje na poboljšanje skrbi o pacijentima.

Download document

Institution: KBC “Sestre milosrdnice”

Country: Croatia

E-mail: tatjana.stiperski@gmail.com

Title: Operacijska sestra alfa i omega operacijske dvorane

Abstract: SAŽETAK Operacijska sala je mjesto koje zahtjeva timski rad, dobru komunikaciju, dinamičnost, učinkovistost, stručnost i efikasnost. Multidisciplinarni tim (anesteziolog, anesteziološki tehničar, kirurg, radiololog, medicinska sestra/ instrumentarka…) koji boravi tijekom operativnog zahvata u operacijskog sali odgovoran je za ishod operativnog zahvata, a samim time i za zdravstveno stanje bolesnika. Cilj rada je predočiti svakodneni rad, zadaće, odgovornost i intrevencije medicinske sestra/ instrumentarke kao ravnopravnog člana multidisciplinarnog tima unutar operacijske sale. Njezine zadaće i intervencije u svakodnevnom radu osim instumentiranja su usmjerene na brigu i sigurnost bolesnika prije i poslje operacijskog zahvata, broj i vrstu instrumenata i implantata, pripremu operacijske dvorane, instrumentiranje prilikom operativnog zahvata i ispunjavanje sestrinkse dokumetacije nakon operativnog zahvata. Instrumentiranje unutar operacijeske dvorane zahtjeva obavljanje niza složenih zadataka koji moraju biti učinjeni, suprotno tome može se ugroziti uspješnost zahvata, a time i zdravlje bolesnika. Posebno poglavlje u svakodnevnom radu medicinske sestare/ instrumentarke predstavlja dezinfekcija, sterilizacija i rad u aseptičnim uvijetima kao preduvijet uspješnog operacijskog liječenja. Medicinka sestra/instrumentarka mora biti visoko educirana, mora pratiti nove smjernice i metode rada u operacijskoj dvorani. Ona mora posjedovati stručnost, vještinu i znanje kako bi bila kvalitetan i ravnopravan član multidisciplinarnog operacijskog tima. KLJUČNE RIJEČI: zadaće medicinske sestre-instrumentarke, instrumentiranje, operacijski zahvat.

Download document

Institution: KBC “Sestre milosrdnice”

Country: Croatia

E-mail: marina.djakulovic@gmail.com

Title: Zadaće operacijskih sestara kod intraoperativne primjene Gama detekcijske sonde

Abstract: Koncept radionavigacije u kirurgiji razvijao se zadnjih 60 godina. U radu će biti prikazan primjer upotreba gama navigacijeske sonde kod tretiranja osteoid osteoma, pri čemu je stavljen naglasak na zadaće operacijske sestare – instrumentarke pri ovom dijagnostičko – kirurškom zahvatu. Zadaće operacijske sestare – instrumentarke kod inovativnih i nesvakidašnjih tehnika u kirurgiji kao što je upotreba radionavigacije zahtjevaju posjedovanje visokog stupnja znanja, stučnosti i vještina. Njezine intervencije započimnju pripremom bolesnika pri ulasku u operacijski blok, pripremom specifičnog instrumentarija i opreme kao i osiguranje sterilnosti istih. Osim svih operacijskih protolola koje primjenjujemo u Klinici za traumatologiju, KBC Sestre milosrdnice , operacijska sestra u prvom redu mora brinuti za sigurnost bolesnika i zaštitu od zračenja kako za operacijski tim, tako i za samog bolesnika. Upotreba radionavigacije u kirurgiji zahtjeva educirane operacijske sestre koje poznaju samu tehniku zahvata u cilju što bolje pripreme bolesnika za zahvat i sprječavanju potencijalnih komplikacija. Ona svojim znanjem, vještinama i holističkim pritupom u skladu sa svojim kompetencijama pridonjet će što bržem provođenju ovog dijanostičko-terapijskog zahvata, a samim time i krećem boravku bolesnika u bolnici. Ključne riječi: gama navigacijska sonda, operacijski blok, zadaće medicinkse sestre.

Download document

Institution: KBC “Sestre milosrdnice”

Country: Croatia

E-mail: suncica.babic1@gmail.com

Title: Zadaće instrumentarke kod ugradnje tumorske endoproteze donjih ekstremiteta

Abstract: Napredak kirurških tehnika i prateće industrije implantata pri rekonstruktivnim ortopedsko – traumatološkim zahvatima na donjim ekstremitetima nosi sa sobom zamke koje se mogu očitovati u potencijalnoj ljudskoj pogrešci zbog nedovoljno dobrog poznavanja operacijske tehnike i implantata. Medicinska sestra- instrumentarka, kao član multidisciplinarnog tima, mora imati praktično i terorijsko znanje kod ove vrste zahvata. Njezine zadaće koje mora ispunjavati tijekom zahvata zahtijevaju poznavanje važnosti specifičnog instrumentarija, sastavnih dijelova implantata i mogućih kombinacija unutar istih. Sama tehnika instrumentiranja i sudjelovanje u pripremi bolesnika za takav zahvat u većini slučajeva mogu biti od presudnog značaja u svrhu eliminacije ljudske pogreške. Operacijski zahvati ugradnje rekonstruktivnih endoproteza donjih ekstremiteta zahtijevaju educirano osoblje koje u cijelosti poznaje operacijsku tehniku, a zbog složenosti operacije i veći broj operacijskih sestara od uobičajenog.

Download document

Institution: KBC “Sestre milosrdnice”

Country: Croatia

E-mail: vesna.svircevic@gmail.com

Title: Zadaci operacijske sestre kod prednje vratne diskektomije

Abstract: Kod gotovo % populacije u dobi do godina a čak % u dobi od godina rendgenski se nalaze znakovi degenerativnih promjena ( spondiloze ) vratne kralje š nice Do sredine – ih godina stolje ć a za bolesnike s vratnom spondilozom rutinski je kiru š ki pristup bio stra ž nji Problem kod tog pristupa je taj š to se i disk a i ve ć ina degenerativnih promjena ( osteofita ), nalaze sprijeda u odnosu na le đ nu mo ž dinu te je te š ko posti ć i adekvatnu dekompresiju Neadekvatni rezultati stra ž njeg pristupa ali i napredak operacijskih tehnika doveli su do otkri ć a prednjeg pristupa – ih godina pro š log stolje ć a Vratna spondiloza ima u osnovi bolest intervertebralnog diska koji gubitkom svojih elasti č nih svojstava dovodi posljedi č no do promjena na kostima odnosno mekim tkivima Osnovna patolo š ka karakteristika je gubitak sadržaja vode u nukleosu pulposusu te gubitak elasti č nih svojstava Operacijska sestra mora imati stru č no teorijsko i prakti č no znanje š to joj omogu ć ava da bude pripremljena na sve mogu ć e komplikacije Ona mora dobro poznavati sve faze operacije kako bi pratila kirurga u njegovom radu i kako bi znala pripremiti potreban instrumentarij i na vrijeme reagirati u svakoj prilici Uloga operacijske sestre da poma ž e operateru zahtjeva i u prvi plan stavlja njezinu sposobnost dobre mehani č ke intervencije Dobra komunikacija tako đ er je va ž an element za uspje š an i profesionalni rad u bilo kojem zanimanju pa tako i u radu operacijske sestre kako sa osobljem i suradnicima na poslu tako i sa pacijentima Kako bi se bolje osje ć ali i bili uspje š niji u svojoj profesionalnoj ulozi

Download document

Institution: KBC “Sestre milosrdnice”

Country: Croatia

E-mail: cecilijagb@gmail.com

Title: Radionica: Sestrinska dokumentacija

Abstract: Povijest dokumentiranja u sestrinstvu seže daleko u povijest. Zapisi iz drevnog Egipta osim o veterinarskoj znanosti i kirurgiji sadrže opisane sestrinske intervencije ( postavljanje zavoja i hranjenje pacijenta s tetanusom ). Najveća pažnja primjeni sestrinske dokumentacije posvećuje se uvođenjem procesa zdravstvene njege. Dokumentacija predstavlja vezu između svih faza procesa zdravstvene njege. U našoj zemlji nakon osnutka HKMS i donošenja Zakona o sestrinstvu MS imaju obavezu dokumentiranja. Izrađena je jedinstvena sestrinska lista koja se može prilagoditi potrebama bolesnika. Razlozi za postojanje sestrinske dokumentacije i dokumentiranje su profesionalna odgovornost prava zaštita standard sestrinske prakse zakonska osnova troškovi u zdravstvu i menadžment i društvene promjene. U RH je sestrinska dokumentacija regulirana i zakonskim propisima. Pravilnikom o sestrinskoj dokumentaciji u bolničkim zdravstvenim ustanovama ( NN ) propisani su obavezni dijelovi sestrinske dokumentacije te izdane upute za njihovu primjenu. Sestrinska dokumentacija označava skup dokumenata koje MS ispunjava ili u koje zapisuje podatke o svojim postupcima tijekom cjelokupnog procesa skrbi za pojedinca sa svrhom sustavnog praćenja stanja planiranja vrednovanja i kontrole učinjenoga. Sestrinska dokumentacija mora biti dokaz provedene skrbi i odgovora na tu skrb te osigurati zapise o bolesnikovoj sigurnosti ( procjena rizika zaštita uočavanje promjena dokumentiranje incidenata i ne željenih događaja). Uvođenje procesa zdravstvene njege i sestrinske dokumentacije u svakodnevni rad medicinskih sestara i skrb za pacijenta predstavlja temelj početka procesa kontinuirane evaluacije provedene skrbi i unaprjeđenja kvalitete. Ona mora opisivati i osigurati komunikaciju o bolesnikovu statusu među zdravstvenim profesionalcima i između smjena. Dokumentiranje u sestrinskoj

Download document

Institution: KBC “Sestre milosrdnice”

Country: Croatia

E-mail: maricmartina@net.hr

Title: Primjena suvremenih obloga u kliničkoj praksi kod opeklina i traumatološkog bolesnika

Abstract: Akutne i kronične inficirane rane zbog sporog cijeljenja i komplikacija predstavljaju velik financijski problem. Tupferi i zavoji danas imaju samo povijesno značenje. Danas postoje obloge za rane koje podržavaju osnovne fiziološke uvjete za cijeljenje rane. Proizvodi za njegu rane bazirani su na naprednoj teoriji vlažnog cijeljenja za koje je dokazano da ubrzava cijeljenje rane smanjuje rizik od infekcije te osigurava pacijentu atraumatski način prevoja. Kako odabrati određenu oblogu ostaje osnovno pitanje, no najvažniji je individualan pristup svakom pacijentu kako bi se postigli brži bolji i kvalitetniji način liječenja Med. sestra zajedno s kirurgom bira oblogu na osnovi kliničkog iskustva. Cilj rada je prikazati naša iskustva na Klinici i razmjena mišljenja s kolegicama istih ili sličnih slučajeva. Cijene suvremenih obloga su više u odnosu na klasične materijale, ali su ukupni troškovi liječenja smanjeni. U radu će biti prikaz slučaja pacijenta s opeklinama IIb – III stupnja koji je liječen u periodu od dva mjeseca kombinirano nekrektomijom i plastikom autotransplantata te primjenom obloga s hidrofiber tehnologijom obogaćenoj ionima srebra. Liječenje će biti prikazano po fazama cijeljenja uz fotografije. Također će biti prikazan slučaj pacijenta s ranom kao posljedicom komplikacija dugotrajnog ležanja ( Philadelphia ovratnik kvadriplegija ) za koju je primijenjena hidrokoloidna obloga. Faze cijeljenja rane će biti prikazane fotografijama. Zbog raznovrsnosti rana te individualnog pristupa svakom pacijentu očito je da samo jedna vrsta obloge za rane ne može zadovoljiti sve terapeutske potrebe. Liječenje kronične rane.

Download document

Institution: KBC “Sestre milosrdnice”

Country: Croatia

E-mail: maryk810@gmail.com

Title: Standardizirani postupci traumatoloških bolesnika kod ozljede zdjelica

Abstract: UVOD Medicinska sestra kao član tima uključena je u sam proces skrbi za bolesnika od trenutka njegovog prijema na odjel do otpusta.Provodi najviše vremena uz bolesnika i može procjeniti njegov fizički,psihički i emocionalni odgovor na zahtjeve zdravstvene njege. Literatura: 1.Kalauz S. Zdravstvena njega kirurških bolesnika(nastavni tekstovi)Visoka zdravstvena škola,Zagreb 2000 2.Nastavni materijali(moodle)Zdravstvenja njega kirurškog bolesnika,Neuberg M.(2013) 3.Fučkar G. Proces zdravstvene njege(1992) 5.Orlić D.Život s umjetnim zglobom kuka(1993) 6.Smiljanić B. Traumatologija,školska knjiga(2003) MATERIJALI I METODE Proteza kuka ili koljena se ugrađuje ako se ne mogu popraviti konzervativnim liječenjem. Postoje totalne proteze, kojima se zamjenjuje cijeli zglob kuka i bescementne.Postoje i parcijalne proteze, kojima se zamjeni samo glava bedrene kosti. Proteza koljena se sastoji iz natkoljenog i potkoljenog dijela. Operacija ugrađivanja umjetnog zgloba kuka ili koljena danas se često obavlja u našoj ustanovi i još uvijek se ubraja u složene operacijske zahvate. Bolesnika se 15 dana prije zahvata obavijesti i dobije upute o preoperativnim pretragama. Pretrage su: krvne pretrage,KG,urin,urinokultura,Rtg pluća,EKG srca,anesteziološki pregled,te ako je potrebno internistički pregled. Preoperativna priprema bolesnika se sastoji od uzimanja anamneze,pregled bolesničke dokumentacije,ispisivanje temp.liste,izrada plana zdravstvene njege,smještaj bolesnika u sobu, ,naručivanje transfuzijskih pripravaka.Postooperativno razdoblje uključuje kontrolu vitalnih fukncija,uočiti promjene u tjelesnom sustavu,kontrola lab.nalaza(KS),kontrola krvarenja,prevencija.

Download document

Institution: KBC “Sestre milosrdnice”

Country: Croatia

E-mail: draganadunaj@gmail.com

Title: Standardni operativni postupci sop kod bolesnika s prijelomom kuka

Abstract: Prijelom kuka je velik zdravstveni i socijalni problem unutar nacionalnog zdravstvenog sustava. Standardni operativni postupci (SOP) su detaljno napisane upute kako bi se postigla ujednacenost za obavljanje odredjene funkcije pa tako i u segmentu pruzanja ortopedsko-traumatoloske zdravstvene zastite. Pretpostavka je da bi uvodjenje SOP u Kliniku za traumatologiju KBC „Sestre milosrdnice“ doprinijelo mnogim poboljsanjima, a pod time se najvise misli na brzi, laksi i kvalitetniji oporavak bolesnika, bolju koordinaciju izmedju bolnickog tima i bolju brigu o bolesniku nakon odlaksa iz bolnice kao i smanjenje troskova. Pri izradi SOP-a provedena je retrospektivna studija u Klinici. U studiji je ukljuceno 382 bolesnika od toga je 267 zena i 115 muskaraca prosjecne zivotne dobi 74 godine (14-102 godine). Koristen je upitnik iz dostupnih podataka Bolnickog informatickog sustava te su obradjeni u tablicnom programu. Koristena je deskriptivna metoda obrade podataka, kao i medjunardona iskustva. Uzorak je prigodnog tipa te su ga cinili svi bolesnici koji su boravili u Klinici od 1.1.2014. do 31.12.2014. god. Nakon provedene analize moze se zakljuciti da nedostatkom SOP-a na Klinici nema zadovoljavajuce sestinske dokumentacije, nema pracenja nacela po kojem se od samog pocetka, sto je vise moguce, moze izbjeci pojava pogreske. Kako bi se moglo dokazati da je posao dobro obavljen nuzno je sve dokumentirati. Potrebno je provoditi sestrinsku skrb po striktnim uputama SOP-a pri cemu ne smije biti razlike u kojoj se regiji, gradu ili bolnici obavljaju. Medjutim s obzirom na opseg SOP-a trebali bi razlikovati nacionalnu razinu, regionalnu i gradsku. Uvjeti za razvoj SOP-a se baziraju na opsegu javno zdravstvenih djelatnosti, klinickoj praksi i vjestini, kao i na napretku medicinske tehnologije Kljucne rijeci: SOP, prijelom kuka, Klinika za traumatologiju, sestrinska skrb.

Download document

Institution: KBC “Sestre milosrdnice”

Country: Croatia

E-mail: nevenka.lukavski@kbcsm.hr

Title: SOP Standardizirani operacijski postupci u ortopedsko – traumatološkoj operacijskoj sali

Abstract: Ovim radom želimo prikazati standardizirane operacijske postupke u ortopedsko – traumatološkoj operacijskoj sali zahtjevnost i odgovornost svakodnevog posla medicinskih sestara – instrumentarki u cilju besprijekornog izvođenja operacijskog zahvata na dobrobit pacijenta. Materijali i metode – Svakodnevni višegodišnji rad i iskustvo – Provjera opreme u operacijskoj sali prije početka zahvata – Provjera sterilnosti općeg i specijalnog instrumentarija dan ranije i na dan zahvata – Provjera potrebnih implantata ili komponenti – Provjera opreme u operacijskoj sali prije početka zahvata – Provjera popunjenosti operacijske sale sa svim potrebnim sanitetskim materijalom – Priprema operacijske sale ( priprema operacijskog stola sa nastavcima specifičnim za određeni zahvat itd ) – Ispunjavanje „ Cheeking “ liste ( provjera indentiteta pacijenta strane i mjesta incizije predstavljanje pacijentu kirurškog tima koji će sudjelovati u operacijskom zahvatu itd ) – Provođenje operacijskog zahvata i instrumentiranje – Pranje održavanje i pakiranje instrumenata za sterilizaciju – Ispunjavanje sestrinske dokumentacije koja uz „ Cheeking listu „ uključuje „ Obrazac potrošenog sanitetskog materijala “ „ Protokol operacijske sestre “ „ Odjavne liste “ potrošenih impantanta ili komponenti Unos u BIS ( bolničko informacijski sustav ) šifriranih potrošeni lijekova medicinskog i sanitetskog materijala. Zaključak Iako u našoj prezentaciji nismo mogle

Download document

Institution: KBC Rijeka

Country: Croatia

E-mail: ivankabv@gmail.com

Title: Standardni Operativni Postupci u operacijskoj sali za traumatologiji

Abstract: Ključne riječi Standardni Operativni Postupci dokumentacija prijelomi traumatologija. Sažetak Važan aspekt sustava kvalitete je raditi u skladu sa jasnim standardnim operativnim postupcima ( SOP ). U stvari cijeli proces od uzorkovanja do podnošenja analitičkog rezultata treba opisati kontinuiranim nizom SOP Standardni operativni postupak je dokument koji opisuje redovito ponavljajući operacije važne za kvalitetu rada. Svrha SOP je za obavljanje poslova ispravno i uvijek na isti način SOP trebaju biti na raspolaganju na mjestu gdje je djelo postupak učinjen. Standardizirani postupci u zdravstvenoj njezi predstavljaju pravila po kojima su medicinske sestre dužne postupati. Jedinstveni način provođenja postupaka osigurava isti standard i sigurnost za svakog bolesnika. Vremenski i kadrovski normativi koji proizlaze iz „ Standardiziranih postupaka “ omogućavaju planiranje potrebnog broja medicinskih sestara i nužnost razine obrazovanja što je važno za organiziranje provođenja zdravstvene njege. Određivanjem vremenskih i kadrovskih normativa racionalno se koriste ljudski potencijali. Vremenski normativi su procijenjeni temeljem mjerenja jedinice vremena u kliničkim uvjetima, a kadrovski temeljem kompetencija medicinskih sestara. Standardizirani postupci su pisani na način koji omogućava korisniku i medicinskoj sestri racionalno shvaćanje provedbe postupka. Koraci provedbe postupka omogućavaju optimalnu iskoristivost vremena prostora i materijala. Razvidne su kompetencije. Primjena standardiziranih postupaka otklanja organizacijske probleme i konflikte među zaposlenima. Odličan su edukacijski materijal za novozaposlene pripravnike i studente. Pogodni su sa sestrinskom listom i kategorizacijom pacijenata ovisno o potrebama za zdravstvenom njegom za određivanje optimalnog broja medicinskih sestara u zdravstvenoj ustanovi.( citat HKMS ) Nekoliko kategorija i vrste SOP može se razlikovati.

Download document

Institution: KBC Zagreb

Country: Croatia

E-mail: vesna.kljaic@gmail.com

Title: Koštana banka

Abstract: Koštana banka je organizirani sustav nabave, obrade, pohrane i distribucije muskulo – skeletnog tkiva sa svrhom njegove upotrebe u ortopedsko – traumatološkoj kirurgiji. Povijest koštanih presadaka i koštane transplantacije duga je preko stotinu godina u svijetu. Klinika za ortopediju Kliničkog bolničkog centra Zagreb je najstarija ustanova u Hrvatskoj u kojoj se upotrebljavaju koštani presadci i djeluje neprofitna koštana banka. Presadci se uzimaju od živih i mrtvih darovatelja. Živi darovatelji su bolesnici kojima se odstranjuje glava bedrene kosti zbog ugradnje totalne endoproteze kuka i koji daju svoj informirani pristanak. Od 2009 godine uzima se i spongiozni čep iz kanala bedrene kosti. Od mrtvih darovatelja muskulo – skeletni presadci se uzimaju kod multiorganskih eksplantacija. Svi presadci podliježu mikrobiološkoj analizi i skladište se u zamrzivaču na – 800C u kontroliranim uvjetima. Porijeklo presatka i njegova sljedivost uredno se dokumentira. Eksplantacijski tim čine liječnici ortopedi i medicinske sestre instrumentarke. Hrvatska je član Eurotransplanta od 2007. i banke tkiva rade prema direktivama Europske unije. Ključne riječi: koštana banka, koštani presadak, darovatelj, eksplantacija.

Download document

Institution: KBC “Sestre milosrdnice”

Country: Croatia

E-mail: lucelana@gmail.com

Title: Zadaci operacijske sestre kod prednje vratne diskektomije

Abstract: Kod gotovo % populacije u dobi do godina, a čak % u dobi od godina rendgenski se nalaze znakovi degenerativnih promjena ( spondiloze ) vratne kralješnice. Do sredine – ih godina stoljeća za bolesnike s vratnom spondilozom rutinski je kiruški pristup bio stražnji. Problem kod tog pristupa je taj što se i disk a i većina degenerativnih promjena ( osteofita ), nalaze sprijeda u odnosu na leđnu moždinu te je teško postići adekvatnu dekompresiju. Neadekvatni rezultati stražnjeg pristupa, ali i napredak operacijskih tehnika doveli su do otkrića prednjeg pristupa – ih godina prošlog stoljeća. Vratna spondiloza ima u osnovi bolest intervertebralnog diska koji gubitkom svojih elastičnih svojstava dovodi posljedično do promjena na kostima odnosno mekim tkivima. Osnovna patološka karakteristika je gubitak sadržaja vode u nukleosu pulposusu te gubitak elastičnih svojstava. Operacijska sestra mora imati stručno teorijsko i praktično znanje što joj omogućava da bude pripremljena na sve moguće komplikacije. Ona mora dobro poznavati sve faze operacije kako bi pratila kirurga u njegovom radu i kako bi znala pripremiti potreban instrumentarij i na vrijeme reagirati u svakoj prilici. Uloga operacijske sestre da pomaže operateru zahtjeva i u prvi plan stavlja njezinu sposobnost dobre mehaničke intervencije. Dobra komunikacija također je važan element za uspješan i profesionalni rad u bilo kojem zanimanju pa tako i u radu operacijske sestre kako sa osobljem i suradnicima na poslu tako i sa pacijentima. Kako bi se bolje osjećali i bili uspješniji u svojoj profesionalnoj ulozi.

Download document

Institution: KBC “Sestre milosrdnice”

Country: Croatia

E-mail: valentinastrbac@yahoo.com

Title: Primjena suvremenih obloga u kliničkoj praksi kod opeklina i traumatološkog bolesnika

Abstract: Akutne i kronične inficirane rane zbog sporog cijeljenja i komplikacija predstavljaju velik financijski problem. Tupferi i zavoji danas imaju samo povijesno značenje. Danas postoje obloge za rane koje podržavaju osnovne fiziološke uvjete za cijeljenje rane. Proizvodi za njegu rane bazirani su na naprednoj teoriji vlažnog cijeljenja za koje je dokazano da ubrzava cijeljenje rane smanjuje rizik od infekcije te osigurava pacijentu atraumatski način prevoja. Kako odabrati određenu oblogu ostaje osnovno pitanje, no najvažniji je individualan pristup svakom pacijentu kako bi se postigli brži bolji i kvalitetniji način liječenja. Med. sestra zajedno s kirurgom bira oblogu na osnovi kliničkog iskustva. Cilj rada je prikazati naša iskustva na Klinici i razmjena mišljenja s kolegicama istih ili sličnih slučajeva. Cijene suvremenih obloga su više u odnosu na klasične materijale, ali su ukupni troškovi liječenja smanjeni. U radu će biti prikaz slučaja pacijenta s opeklinama IIb – III stupnja koji je liječen u periodu od dva mjeseca kombinirano nekrektomijom i plastikom autotransplantata, te primjenom obloga s hidrofiber tehnologijom obogaćenoj ionima srebra. Liječenje će biti prikazano po fazama cijeljenja uz fotografije. Također će biti prikazan slučaj pacijenta s ranom kao posljedicom komplikacija dugotrajnog ležanja ( Philadelphia ovratnik kvadriplegija ) za koju je primijenjena hidrokoloidna obloga. Faze cijeljenja rane će biti prikazane fotografijama. Zbog raznovrsnosti rana te individualnog pristupa svakom pacijentu očito je da samo jedna vrsta obloge za rane ne može zadovoljiti sve terapeutske potrebe. Liječenje kronične rane.

Download document

Institution: SB Biograd n/m

Country: Croatia

E-mail: zeljkozuic10@gmail.com

Title: Reimplantacija totalne proteze kuka uloga operacijske sestre tehničara

Abstract: Kroz ovaj rad smo htjeli prikazati indikacije, tijek operacije i komplikacije ovog operacijskog zahvata kao i ulogu op.sestre-tehničara koji priprema sav potreban materijal i instrumente, asistira tijekom operacijskog zahvata pridržava se svih protokola i postupaka kako u pripremi tako i za vrijeme zahvata.

Download document

Institution: SB Akromion

Country: Croatia

E-mail: khrastinski1@gmail.com

Title: Kakvu medicinsku sestru treba pacijent

Abstract: Pacijenti često nemaju predodžbu kako se trebaju ponašati u komunikaciji sa sestrama. Obično imaju predrasude. Profesionalan odnos trebao bi podrazumijevati percipiranje sestre kao osobe koja primjenjuje svoje znanje i vještine u cilju postizanja dobrobiti pacijenta. Sestra treba poštovati pacijentovu jedinstvenost i individualnost, te njegova prava da sudjeluje u procesu njege. Provedeno je istraživanje među pacijentima u kojem je opći nalaz da ispitanici većinom izražavaju pozitivne stavove o sestrama. U prosjeku 61% ispitanika slaže se s tvrdnjama o pozitivnim osobinama m.s., međutim 39% se ne slaže s tim tvrdnjama. Među izjavama o poželjnim osobinama m.s. izražene su slijedećim pridjevima: pažljiva, vesela, suosjećajna, nježna, puna razumijevanja…Među nepoželjnim osobinama izraženu su: osorna, hladno poslovna, hladnokrvna, imuna na patnju, neemocionalna, bezosjećajna… U bolesti, pacijent se prepušta liječniku/sestri, tražeći od njih privremenu fizičku/psihičku pomoć i stavlja se u stanje njihove ovisnosti. Cilj svake medicinske sestre treba biti da stavi bolesnika u situaciju u kojoj će sam moći utjecati na svoj život, s velikim povjerenjem prema pomoći koju mu ona pruža. Svi se ovi postulati mogu savršeno ostvariti, ukoliko sestre u svom profesionalnom radu provode koncept integralne skrbi.

Download document

Institution: SB Akromion

Country: Croatia

E-mail: snjezanamici71@gmail.com

Title: Uloga med. sestre u liječenju akutne boli kod ortopedskih bolesnika

Abstract: Bol je intenzivan osjećaj praćen strahom i tjeskobom koji utječe na cjelovito funkcioniranje organizma i remeti zadovoljavanje svih ljudskih potreba. Dakle, veoma je važno bolesniku ublažiti bol, te time postići bolji poslijeoperacijski oporavak čime se postiže i poboljšanje samog operacijskog zahvata. Intervencije medicinske sestre su da uspostavi odnos povjerenja s bolesnikom, prepozna fazu boli, primjeni propisani analgetik, prepozna neželjene učinke analgetika, podučava o bolovima, planira i primjenjuje nemedikamentne postupke za ublažavanje boli, prati uspješnost ublažavanja boli, planira provođenje njege bolesnika, vodi dokumentaciju o boli i koordinira radom između svih zdravstvenih djelatnika. Medicinska sestra ima mnogobrojne zadaće u poslijeoperacijskoj skrbi bolesnika a za njihovo provođenje važno je poznavanje svih postupaka, njihovo kontinuirano provođenje, stalno monitoriranje bolesnika te timski rad sa drugim sestrama i medicinskim osobljem uključenim u liječenje. Samo pravilnim provođenjem svih postupaka moguće je postići optimalno liječenje poslijeoperacijske boli.

Download document

Institution: SB Akromion

Country: Croatia

E-mail: ivanaccar@gmail.com

Title: Medicinska sestra u pripremi i primjeni orthokin terapije

Abstract: Indikacije za primjenu orthokin terapije: -akutne i kronične zglobne bolesti (artroze koljena, kuka, ramena, lakta i gležnja) -reumatske ozljede hrskavice -lumboishijalgije -traumatske rupture muskulature. U bolnici Akromion terapija orthokinom, aplicirana u koljeno, provedena je kod 41 pacijenta, od toga 19 žena i 22 muškaraca. Kod 6 žena i 1 muškarca orthokin terapija je aplicirana u oba koljena. Orthokin je potpuno biološka metoda liječenja koja ne koristi ništa drugo osim vlastitih endogenih proteina i faktora cijeljenja. Intrervencije medicinske sestre u pripremi orthokin injekcija: 1. Krv iz vene se direktno uzima u specijalne EOT monovete (4 monovete) -posebno tretirane staklene kuglice koje se nalaze unutar monovete lijepe na sebe krvna tjelešca i potiču sintezu zaštitnih proteina tijela. 2. Monovete se pohranjuju u termostat na 37*C 6 sati – što predstavlja optimalne uvjete za kvalitetnu sintezu zaštitnog proteina. 3.Centrifugiranjem 10 minuta na 5 000 okretaja krvna tjelešca se odvajaju od seruma obogačenog visokom koncentracijom zaštitnog proteina, spremamo injekcije po 2ml u štrcaljku. 4. Dobijemo 5-6 injekcija seruma, stavljaju se u označeni spremnik i pohranjuju u zamrzivač 5. Ovisno o indikaciji liječnik aplicira orthokin u zglob jednom tjedno. Zadaće medicinkse sestre/ tehničara prije uzimanja uzorka krvi temelji se na pripremi bolesnika, priprema pribora za uzimanje uzork i priprei bolesnika i pribora za aplikaciju orthokin injekcije.

Download document

Institution: KB Dubrava

Country: Croatia

E-mail: zroje@kbd.hr

Title: Slobodni kožni transplantat; uzimanje, postavljanje i njega

Abstract: Kirurški postupak presađivanja kože uključuje uzimanje kože sa donorskog mjesta i pripremu za pokrivanje defekta nastalog nakon odstranjenja tumora, za pokrivanje opeklinskih rana i defekta nakon debridmana kroničnih i akutnih rana. Tipovi kože transplantata su podijeljeni prema debljini, transplantati djelomične i pune debljine. Za uzimanje transplantata se koristi kirurški instrument dermatom. Slobodni kožni transplantat se pričvršćuje za podlogu malim šavovima ili kirurškim zakovicama, te preživljava na podlozi plazmatskom imbibicijom. Terapija rane negativnim tlakom omogućuje veći postotak prihvaćanja transplantata. Rizici operacije uzimanja slobodnog kožnog transplantata su: krvarenje, infekcija i gubitak presađene kože. Poslije postavljanja transplantata važno je zadržati odgovarajuće uvjete u prva dva dana kako bi se transplantat prihvatio. Stoga prvi prevoj slijedi 3-4 postoperativni dan. Tijekom slijedećih dana primajuća regija se ostavlja 1 sat svaki dan pod “šatorom” da bi omogućilo brže cijeljenje. Njega transplantata zahtjeva znanje i posebnu njegu. Donorsko mjesto treba stvoriti novi sloj epidermisa rubnim cijeljenjem. Potrebno je adekvatno zaštiti ranu tijekom tog cijeljenja. Vrste obloga koje se mogu koristiti kao pokrov donorskog mjesta su : Granuflex, Aquacel, Aquacel Ag,, Kaltostat, Baiten te paste i gelovi. Medicinske sestre su educirane o metodama postavljanja transplantata i postoperativne njege.

Download document

Institution: KB Dubrava

Country: Croatia

E-mail: zroje@kbd.hr

Title: Liječenje V.A.C. VeraFlo sistemom u slučaju izloženog osteosintetskog materijala nakon operacije skolioze

Abstract: Terapija negativnim tlakom (TNT) je neinvazivna metoda zbrinjavanja rane kojom se potiče stvaranje granulacijskog tkiva povećavajući lokalnu prokrvljenost, smanjujem edem i bakterijske kolonizacije. E-poster je prikaz kliničkog slučaja pacijentice od 16 godina koja je bila podvrgnuta operaciji zbog skolioze. Pet godina nakon operacije došlo je do otvaranja rane i ekspoziciji Harrington šipki. Predoperativna primjena KCl-a VeraFlo sistema se koristi kako bi se smanjila bakterijska kontaminacija rane i potaklo stvaranje granulacijskog tkiva. Nakon adekvatne pripreme rane slijedi plastično- rekonstruktivni kirurški postupak kojim se pokrije navedeni defekt i eksponirana šipka. Defekt se pokrio lokalnim mišičnokutani režnjem leđnog mišića, latissimus dorsi. Lokalna infekcije rane je glavni uzrok dehiscence rane. Uporabom V.A.C. VeraFlo sistema potaknulo se smanjenje infekcije uz mehaničko čišćenje rane što je dalo značajan napredak u kvaliteti cijeljenja. Kod pacijentice godinu dana nakon operativnog zahvata rana je još uvijek u dobrom stanju, bez izlaganja materijala. Medicinska sestra sudjeluje u pripremi pacijenta, postavljanju V.A.C sistema, debridmanu rane , odizanju i pripremi režnja te pokrivanju defekta.

Download document

Institution: KB Dubrava

Country: Croatia

E-mail: zroje@kbd.hr

Title: Nekrotizirajući fasciitis trupa

Abstract: Nekrotizirajući fascitis (NF) je brzo šireća infekcija mekih tkiva, obično uzrokovane toksinima koje proizvode bakterije. Rana dijagnoza s agresivnim multidisciplinarnim liječenjem je obvezatna. Standardni pristup liječenju uključuje radikalni kirurški debrideman za uklanjanje nekrotičnog tkiva i intravenozno liječenje kombinacijom antibiotika i parenteralnu nadoknadu u jedinicama intenzivne skrbi. Nakon adekvatne kirurške ekscizije najčešće zaostaje veliki defekt mekih tkiva koje treba zbrinuti. Metoda izbora prije konačnog kirurškog zbrinjavanja je pokrivanje defekta oblogama do stabilizacije pacijenta i relativno urednog brisa rane. Nakon toga kirurško pokrivanje defekta može biti sa slobodnim kožnim transplantatom ili režnjem. Terapija negativnim tlakom ( TNT) se također koristi za pokrivanje defekta ili fiksaciju transplantata. Ovaj e-poster prikazuje klinički slučaj nekrotizirajućeg fascitisa trupa. Kiruršku eksciziju, konzervativnu njegu nastalog defekta mekih tkiva, pokrivanje slobodnim kožnim transplantatom i primjenu terapije negativnim tlakom. Medicinska sestra sudjeluje u pripremi pacijenta za operaciju; uzimanju, pripremi i fiksaciji transplantata te postoperativnoj njezi.

Download document

Institution: Klinika za dječje bolesti Zagreb

Country: Croatia

E-mail:

Title: Korekcija angularnih deformiteta „ Eight plate „ – uloga operacijske sestre

Abstract: Tehnika „8 plate“ se upotrebljava za korekciju angularnih deformiteta kao i izjednačavanja dužine donjih ekstremiteta, a može se koristiti kod djece od 18 mjeseci do 17 godina.Tehnika se koristi od 2003 godine (Stevens), a kod nas od 2012, gdje je do sada ugrađeno preko 100 pločica kod više od 30 pacijenata.Operacija se izvodi u općoj ili regionalnoj anesteziji uz kontrolu pokretnog Rtg pojačivača.
ULOGA OPERACIJSKE SESTRE
Visoko postavljeni standardi aseptičnog rada su preduvjet za uspješan ishod operacijskih zahvata.
• PRIPREMA OP. TIMA
• PRIPREMA OP. POLJA
• PRIPREMA ODGOVARAJUĆEG INSTRUMENTARIJA- OSNOVNI, SPECIFIČNI, RTG POJAČIVAČ
• DEKONTAMINACIJA, OBRADA I STERILIZACIJA SETOVA NAKON OP.

Timski rad sestara, operatera, anesteziologa i anest. Tehničara je CONDITIO SINE QUA NON.

Download document