The Use of Computer Navigation and Patient Specific Instrumentation in Shoulder Arthroplasty: Everyday Practice, Just for Special Cases or Actually Teaching a Surgeon?

BACKGROUND: The use of computer assisted surgery, navigation (NAV) in shoulder arthroplasty is still under discussion, regarding the clinical outcome and prosthesis longevity, especially when combining these factors with cost, time and surgeon's experience. Beside the NAV, there has been in use patient-specific instrumentation (PSI) as an additional tool for more precise glenoid implant position. Surgical NAV and PSI for glenoid implant positioning in anatomic and reverse total shoulder arthroplasty are in last years under observation and discussion. OBJECTIVE: To critically review and evaluate the current literature regarding the use of computer navigation and PSI in shoulder arthroplasty. METHODS: Critical review of the existing literature. RESULTS: Cost-effectiveness, prosthesis longevity and revision arthroplasty rate have not yet been proven clinically. Moreover, heterogeneity is high in studies that include different positioning systems (NAV, PSI and standard instrumentation). Heterogeneity is due to differences in surgical technique, implants, surgeon's expertise, radiographic image analysis technique. CONCLUSION: The use of navigation systems and PSI should be clinically proven in the shoulder arthroplasty. Independent experts' opinion and independent high level studies lack at the moment. There will be still a lot of talk regarding this topic in future.

Somatotypes and hand-grip strength analysis of elite cadet sambo athletes.

The objectives of this research were to establish somatotype and hand-grip strength between elite cadet male and female sambo athletes divided by weight categories.A total of 97 elite cadet sambo athletes, participants of the World Cadets Sambo Championships 2018 participated in the study. Male and female sambo athletes were divided by official weight categories. Anthropometrical variables were taken in order to calculate somatotypes and hand-grip strength. A one-way analysis of variance and Tukey's post hoc tests were used to compare group differences by weight categories.Results of this study provide the first description of somatotype and hand-grip strength of elite male and female cadet sambo athletes in relation to weight category. A typical somatotype in male sambo athletes was endomorphic mesomorphs with a predominance of musculoskeletal tissue, while female athletes differed concerning weight category. Overall, an increase in handgrip strength across weight categories was noted. Hand-grip strength increases linearly from the lightest to the heaviest weight category except in -66 and -84 kg in male athletes. Differences in handgrip strength of female athletes were detected between the lightest group and last six groups in all three variables in favor of last six as well as -44 and kg -48 kg compared with the heaviest.To the best of our knowledge, this study provides the first normative data of somatotype and hand-grip strength analyses in relation to age, gender, and weight categories of cadet sambo athletes. The anthropometric profile of sambo athletes changed according to their weight category. Mesomorphy was the most dominant somatotype component in male athletes, while female had three different types of somatotype component in relation to weight category. In conclusion, we found differences in hand-grip strength related to weight category, which can be linked to the muscle mass of athletes. Future studies should focus on somatotype and strength handgrip values of international compared to national level sambo athletes.

A Mathematical Model of Achilles Tendon Overload During Jump Shot.

INTRODUCTION: Achilles tendon injuries usually occur with abrupt movements at the level of the ankle and foot, and the consequence is the overload of the Achilles tendon. AIM: Examine the Achilles tendon load as a function of the landing angle, and find the critical point at which the tendon overload begins and when a further increase in the landing angle can lead to rupture. METHODS: The study has a prospective character. The input data represent the anthropometric values of the respondents, who are professional basketball players in the senior national team of Bosnia and Herzegovina and were processed in the CATIA v5-6 software solution. Software data processing analyzed the landing angles and the transfer of force to the Achilles tendon. The end result is a regression curve, which projects the angle at which the Achilles tendon is overloaded, and indicates an increased risk of possible injury to the tendon itself. RESULTS: The onset of overloading starts at an angle of 32.28° and at an angle of 35.75° the overloaded load occurs, indicating the need for the subject to change the position of the foot to prevent damage to the tendon itself. CONCLUSION: An angle of 35.75° is the critical point at which the Achilles tendons are overloaded at the very landing. Prevention of injury should go in the direction of practicing the feet for a particular position at the time of the landing, and in the direction to develop adequate footwear that would mitigate the angle at the landing.

Neuralgic Amyotrophy in a 66-year-old Hiker: a Case Report.

INTRODUCTION: Neuralgic amyotrophy (NA) or Parsonage Turner syndrome is a clinical syndrome characterized by sudden attack of neuropathic pain, motor weakness and sensory loss that could be more or less clinically present. Different interpretations regarding the differential diagnosis, symptoms, cause and treatment were given till now. AIM: We report our experience with a 66-year-old male who had a sudden pain attack and palsy in shoulder region, without sensory loss, and associated calcific tendinitis of rotator cuff and degenerative changes in cervical spine. CASE REPORT: Patient came to our hospital with strong pain in shoulder area and signs of frozen shoulder. Active abduction and anteflexion was only to 30 degrees. He experienced the intense pain with visual analogue scale (VAS) 10/10 a night before, during his sleep. No trauma. Neurontin (gabapentin) was given to the patient. After 4 days, he felt better with abduction and anteflexion to 90 degrees. After 2 weeks VAS was 3/10, abduction and anteflection to 100 degrees. CONCLUSION: Neuralgic amyotrophy (NA) is a self-limiting inflammatory disorder usually with idiopathic etiology. The condition can be challenging to treat since many associated symptoms and diagnostic tests and procedures may mimic NA. In that case, accurate differential diagnosis is essential.

Changes in Splenic Volume After the Treadmill Exercise at Specific Workloads in Elite Long-Distance Runners and Recreational Runners.

INTRODUCTION: Spleen acts as blood reservoir both in animals and human beings. Spleen contracts during the exercise and so augment the systemic circulation and helps body to maintain longer on high intensity exercise. Reviewing all available literature, the human spleen shows a decrease in volume, in range from 8% to 56%, depending on the work intensity. AIM: To evaluate the percentage of the decrease in splenic volume after the treadmill exercise at specific workloads: aerobic threshold intensity, anaerobic threshold intensity, submaximal intensity and maximal intensity. METHODS: This prospective study with repeated measurements included 16 healthy subjects, divided in two groups. First group consisted of 8 elite long-distance runners and second group of 8 recreational runners. First testing consisted of treadmill ergospirometry test. This data was crucial for the second testing where subjects were exercising on treadmill at specific workloads. Four specific workloads were determined: treadmill exercise at aerobic threshold intensity (1st workload), anaerobic threshold intensity (2nd workload), submaximal intensity (3rd workload) and maximal intensity (4th workload). Workloads were controlled by the speed of treadmill, for each subject individually regarding the ergospirometry test. Ultrasound measurement of spleen was done before and after each workload. RESULTS: Elite long-distance runners showed greater spleen contraction than recreational runners after four workloads. Spleen contraction was the biggest after the 3rd workload in elite long-distance runners. Smallest contraction was in group of recreational runners after the 1st workload. Statistically significant difference was not found between the groups, regarding the splenic volume after exercise at four specific workloads (p>0.05). CONCLUSION: Elite long-distance runners had greater decrease in splenic volume than recreational runners, after exercise at four specific workloads, without significant difference. Greatest decrease happened in elite long-distance runners, after exercise at submaximal intensity - 49% decrease in splenic volume.

Tetralogy of Fallot - Clinical Course and Treatment as a Mirror of Contemporary Cardiology/Cardiac Surgery Development in Correction of Congenital Heart Disease in the Adults.

AIM: The aim of this paper was to present a 65 year old female patient with chronic heart disease, surgically treated for congenital heart defect type Tetralogy of Fallot. CASE REPORT: In the sixth year of life the patient underwent palliative Potts anastomosis surgery which created an anastomosis between the left pulmonary artery and the descending aorta. Total correction was made in 34 years of life, six months after catheterization, which indicated malignant pulmonary hypertension. She is regularly followed up by the cardiologists and receives daily therapy. The present state of the patient is satisfactory with cardiomegaly, light left ventricular dysfunction, moderate mitral and tricuspid regurgitation, pulmonary arterial hypertension, and aneurysmatic dilatation of left pulmonary artery as well as atrial fibrillation. CONCLUSION: The intense development of cardiology and cardiac surgery in the USA in children and adults over the last fifty years has led to the extension and improvement of the quality of life.

Exercise-Associated Muscle Cramp-Doubts About the Cause.

INTRODUCTION: Exercise-associated muscle cramp (EAMC) is one of the most common conditions that occur during or immediately after the exercise, with questionable etiology. AIM: Aim of article was to present doubts about the cause of EAMC, whether it is primarily a neurological condition or it is water and salt imbalance. RESULTS: Strongest evidence supports the neuromuscular aetiology with the focus on the muscle fatigue. Muscle overload and fatigue affects the balance between the excitatory drive from muscle spindles and the inhibitory drive from the Golgi tendon organs (GTO). This results in a localized muscle cramp. Since the dehydration and electrolyte depletion are systemic abnormalities, it is not clear how these changes would result in local symptoms such as cramping of the working muscle groups. CONCLUSION: "Triad" of causes might be behind the etiology of EAMC, although the "altered neuromuscular control" theory with the "dehydration" theory is the most cogent descriptive model that explains the origin of EAMC. Treatment and prevention strategies for EAMC include: electrical cramp induction, kinesio taping and compression garments, massage therapy, electrolyte supplementation and hydration, corrective exercise, stretching, quinine, pickle juice, hyperventilation strategies.

The Effect of Prehabilitation on Postoperative Outcome in Patients Following Primary Total Knee Arthroplasty.

INTRODUCTION: Osteoarthritis (OA) is the most common joint disease in the world. At the end stage of the disease, usually when patients cannot handle the pain anymore, the knee replacement surgery is the most common and effective treatment to reduce pain and improve functionality. The effect of preoperative exercise (prehabilitation) for patients undergoing total knee arthroplasty (TKA) is still controversial. AIM: To investigate the effect of prehabilitation on postoperative outcome and compare the results of the intervention with the control group. MATERIAL AND METHODS: This prospective study included 20 patients with a diagnosis of gonarthrosis, aged 48-70, who were randomly allocated to either the intervention group or control. Ten patients (intervention group) underwent a 6-week home-based exercise program before the TKA surgery. All patients were assessed by Knee Score (KS), Function Score (FS), and Body Mass Index (BMI) according to the following schedule: 6 weeks before surgery (for intervention group it meant before the prehabilitation program), just prior to surgery (for intervention group it meant after the prehabilitation program), after the surgery, at 3rd month, 6th month, and 12th month postoperatively. They were all operated by the same surgeon, for the primary total knee replacement (Zimmer NexGen Complete Knee Solution) at the Clinic for Orthopaedics and Traumatology, Clinical Centre University of Sarajevo, from October 2016 to June 2017. RESULTS: There is statistically significant difference for Knee and Function Score between the intervention and control group in testing time: just before surgery-meaning that KS and FS increased after the prehabilitation program. Knee Score was significantly different between the two observed groups postoperatively, 3 months postoperatively and 6 months postoperatively, while the Function Score was not significantly different in that period. Prehabilitation program provides better preoperative KS and FS, and better KS up to 6 months postoperatively. However, 12 months postoperatively there was no significant difference between the intervention and control group for the Knee and Function Score. CONCLUSION: Prehabilitation brings significant difference regarding the Knee Score in favor of the intervention group preoperatively and up to 6 months postoperatively.

Splenic Localization of Primary Hydatid Cyst in a 27-Year-Old Sportsman Treated by PAIR Technique: Imaging Anatomy Assessment.

INTRODUCTION: In this paper, we report our experience with a case of primary hydatid cyst involving only the spleen in a 27-year-old sportsman treated by PAIR technique. CASE REPORT: Five years before, a 27-year-old handball player being admitted to our hospital, it was detected the cyst in his spleen which size was 35 x 30 mm in diameter, by abdominal ultrasound during a systematic examination. There was no pain or any other symptoms at that time. Tests on the presence of echinococcus cysts were negative. After a period of 5 years, and regular check-ups, the patient began to feel a dull pain in the left upper quadrant area. The Echinococcus test was again negative. Puncture and aspiration of content was performed and sent to cytological analysis that confirmed the presence of Echinococcus. The CT finding showed the spleen in a normal position, shape, enlarged, 185 mm in longitudinal diameter (splenomegaly), with inhomogeneous parenchyma on the expense of rounded area with hyperdense halo, which did not opacify after contrast, located in the dorsal area of the spleen, 100x98 mm in diameter and which corresponded to the echinococcal cyst in differential diagnosis-clean dense contents (protein / haemorrhagic). CONCLUSION: The reported case is very specific, considering that handball is contact sport, where it is almost impossible to avoid the physical contact between players, which is sometimes even rough. Due to rough contacts, spleen trauma is something we should be very aware about, especially in cases of splenomegaly with hydatid cyst, where the spleen rupture might lead to fatal outcome. According to all this, careful follow up of this patient is necessary.

Minimally Invasive Treatment for Appendiceal Mass Formed After Acute Perforated Appendicitis.

The optimal treatment for appendiceal mass formed after appendiceal rupture due to acute appendicitis is surrounded with controversy. The treatment strategy ranges from open surgery (emergency or interval appendectomy), laparoscopic appendectomy, and image-guided drainage, to conservative treatment with or without antibiotics. Nonsurgical treatment (including conservative and drainage treatment), followed by interval appendectomy to prevent recurrence, is the traditional management of these patients. The need for interval appendectomy after a successful conservative or/and image-guided drainage treatment, has recently been questioned as the risk of recurrence is relatively small. Several authors consider that even in cases involving only ambulatory follow-up observation, without interval surgery after conservative management, the recurrence rate and risks of missing underlying pathologies were not high. This article evaluates the minimally invasive treatment modalities in the management of appendiceal mass, risk of undetected serious disease, and the need for interval appendectomy to prevent recurrence.