Introduction:This study was conducted to analyze the reliability of clinical diagnosis in ACL tear injuries.Material and methods:All patients attending our clinic with knee pain from 2009 to 2013 underwent systematic and thorough clinical assessment. From one hundred and three patients with knee problems in 73 were arhroscopicaly diagnosed ACL tears. All these patients underwent therapeutic arthroscopic knee surgery. The clinical diagnosis was confirmed during this procedure. The accuracy, sensitivity and specificity were calculated based on these arthroscopic findings.Results:The accuracy of clinical diagnosis in our study was 82.5% for ACL tears. Our study revealed high sensitivity and specificity and almost high accuracy for ACL injuries of knee joint in comparison to arthroscopy. MRI is an appropriate screening tool for therapeutic arthroscopy, making diagnostic arthroscopy unnecessary in most patients.Conclusion:Magnetic resonance imaging is accurate and non invasive modality for the assessment of ligamentous injuries. It can be used as a first line investigation in patients with soft tissue trauma to knee.
AIM:The aim of this paper was to present a case with the successful treatment of decubitis ulcer stage IV in the patient with polytrauma and vertical share pelvic fracture and diagnosed entherocollitis combined with deep wound infection with Clostridium difficile treated with combined Negative Pressure Wound Therapy (NPWT) and faecal management system.CASE REPORT:Patient D.S.1967 treated on Traumatology Clinic after tentamen suicide on 9.2.2015 with diagnosis: brain contusion; contusion of thoracal space; vertical share pelvic fracture; open fracture type II of the right calcaneus; fracture of the left calcaneus; fracture on the typical place of the left radius; fracture of the right radius with dislocation. As a first step during the treatment in Intensive care unit we perform transcondylar extension of the left leg, and in that time we cannot operate because of the brain contusion. Four weeks after this treatment we intent to perform stabilisation of the pelvic ring, fixation of both arms, and fixation of both calcanear bones. But at the time before performing the saurgery, the patient got an intensive enterocollitis from Escherichia colli and Clostridium difficile, and during the inadequate treatment of enterocollitis she got a big decubitus on both gluteal regia Grade IV and deep muscular necrosis. Several times we perform a necrectomy of necrotic tissue but the wound become bigger and the infection have a progressive intention. In that time we used VAK system for 6 weeks combined with faecal management system and with local necrectomy and system application of Antibiotics and Flagyl for enterocollitis in doses prescripted from specialists from Infective clinic. This new device to manage faecal deep decubital infection and enterocollitis with Clostridium difficile are considered as adequate. 8Flexi-Seal® FMS has been also used. After two months we succeed to minimize the gluteal wound on quoter from the situation from the beginning and we used for next two months wound treatment from Departement for Plastic and Reconstructive Surgery.CONCLUSION:When faecal incontinence as a result of enterocollitis with Clostridium difficile does occur, a limiting contact with the patient’s skin is extremely important as breakdown can occur rapidly. In addition to tissue injury, faecal incontinence can have a major impact on the patient’s dignity and result in prolonged hospital stay. The main outcomes assested in the case studies were resolution of of decubital ulcers as a result of faecal incontinence, patient comfort and ease of application of the FMS and NPWT. The soft flexible catheter was easily inserted without discomfort to the patients. It gently conformed to the rectal vault, reducing significantly the risk of necrosis, and the risk for prolonged necrosis in cases with previously developed necrosis. FMS was successful in diverting faecal fluid away from the perineal tissue and resolved any decubitus ulcer developed previously in combination with use of NPWT. So, we can recommend this combination in those cases espec...
Background. The prevalence of hip fractures is steadily increasing, as the population ages. These fractures are associated with significant morbidity and mortality. Most of these fractures are treated surgically. Factors related to surgical intervention can play a significant role in the outcome. This study examines the association of in-hospital mortality with the timing of surgery, sex, and age of patients treated surgically due to a hip fracture at Clinical Hospital Shtip in a 2-year long period. Material and Methods. A total of 348 patients admitted with a diagnosis of hip fracture who were treated surgically were identified. Data about sex and age were collected. The outcome was assessed for groups treated within 24, 48, 72, and more than 72 hours after admission. Descriptive statistical methods, chi-square test, t-test for independent samples, and odds - ratio with 95% confidence interval (CI) were used in statistical analysis. Results. The delay of surgical treatment beyond 24 hours did not increase the risk of death (OR=0.65, 95%CI=0.23-1.73). Delays beyond 48h and 72h increased the risk of death progressively (OR=1.17, 95%CI=0.50-2.75, and OR=1.65, 95%CI=0.69-3.95 respectively). Mortality was significantly higher in the 76-85-years age group. Conclusions. Association between surgical delay and in-hospital mortality in hip fracture patients is disputed. Confounding factors such as age, sex, comorbidities, and type of treatment determine the outcome. Patients with hip fractures, without any additional disease, should be operated on as soon as possible after admission to the hospital. Delay beyond 48 hours may increase the risk for in-hospital mortality.
Treatment of the long bones defects and non-unions are among the most challenging cases to solve in the orthopaedic surgery. In these rare and difficult cases the method of compressiondistraction osteogenesis can be the only limb salvage procedure to promote healing of the bone with comprehensive approach to all aspects of the condition.Objective of this retrospective one centred study is to perform both radiological and functional evaluation of the treatment of tibial non-unions with segmental bone defects or significant axial deviation using the method of compression -distraction osteogenesis with the Ilizarov apparatus. In the period between 2006 and 2018 15 patients were surgically treated using this method (in 9 of them as an intercalary bone transport and in other 6 as a continuous distraction with correction of axial deviation). There was an average of 22.9 months from injury and all of them underwent previous surgeries with an average of 2.3/patient. ASAMI (Association for studying and application of Ilizarov methods) scoring system was used for both radiological (bone) and functional results. Also patient's satisfaction with the achieved results was ranked postoperatively. 80% of the patients achieved satisfactory (good and excellent) bone results and 73% satisfactory functional results. Approximately 87% of the patients were personally satisfied with the achieved results.The method of compression -distraction osteogenesis using Ilizarov apparatus proved to be effective as a limb salvage procedure with high degree of excellent and good both radiological and functional results.
AIM: The aim of this paper was to present application of the first expert arthrodesis nail in our clinic to a patient with previous performed arthrodesis according to Ulrich Holz.CASE REPORT: Patients A.M. on the age of 22 (1992) have a motor vehicle injury, (fall from a motor bike) with diagnosis polytrauma, shock, supra and transcondyar open fracture of the right femur III degree, open fracture of the right tibia and fibula. We perform reposition and fixation of supra and transcondyar femoral fracture with “cobra” plate. Also we perform reposition and fixation of right cruris with external fixation. After the operation we found fistula in the place of operation of the right crural regia. During the time the infection goes worse and the patient develop osteomyelittis on the right crural regia. After 5 months with therapy the situation become calm. We remove the external fixation. The patient develops severe “pes equinus” on the right leg and he cannot walk. We try to reduce this equines situation with elongation of the Achilles tendonin the first step, and because we didn’t solve the problem we continue with complete section of the Achilles tendon and after that we perform osteotomy of the right talocrural joint simultaneous to tibia plafond and talus and resection of fibula 2sm.above the syndesmosae tibiofibularis and we fixed the talocrural joint with two screws according the technique of Ulrich Holz.CONCLUSION: So we received fixed position on of the food on 110 degrees which was steel unacceptable for normal walking. At last we remove the screws, make once again osteotomy with positioning of the food in maximal dorsiflexion and perform the Experf Hindfood arthrodesis nail so with this method we achieve correction of dorsiflexion on 95 degrees, and the patient become satisfied because he can walk without support.
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