ABSTRACT
PURPOSE OF THE STUDY: Imobilisation of wounded extremity decreases pain and shock, diminishes the possibilities of soft tissue, vessels and nerves injury with bone fragments, that influences the volume and success of surgical debridement of the wound. Optimal external fixator for war purposes must be rigid in construction, have to be simple to master, allow simple approach to wound during the whole period of fixation, have to be in sterile package with all its necessary part and should not be too expensive. DESIGN OF THE STUDY: Prof. Korzinek in correspondence with "Instrumentarija" from Zagreb developed a new type of external fixateur applicable in war situation and natural disasters. It was named CMC (Croatian Medical Corps) external fixateur, and it ensures imobilisation of extremity during transport to area of final treatment and it could also ensure conditions for definitive fixation. CMC is compound of bar, clamps and Schanz screws. Standard packing are CMC-30 and CMC-40. CONCLUSION: CMC external fixator is the applicable device in war and natural disaster situations. It is simple to master even for less experienced surgeons, it's low volume allows appropriate wound treatment, it could be resterilised and reused and it has acceptable price.
Subject(s)
External Fixators , Extremities/injuries , Fracture Fixation/instrumentation , Croatia , Equipment Design , Humans , Transportation of Patients , WarfareABSTRACT
PURPOSE OF THE STUDY: The most severe injuries during defense war in Croatia were caused by projectiles of high kinetic energy. Shell fragments bone they break the bone, transferring bone segments into additional individual projectiles. During this process periostal and endomedullary circulation is cut off reducing to a minimum the possibility of healing, leading to defects in long bone diaphyses. These are referred to as defect pseudoarthroses and are among the most difficult problems in reconstructive surgery of the musculo-articular system. This article presents bone segment transport as a method of choice for treating defect pseudoarthrosis. MATERIAL: During the defense Croatian war, in six-years period, 62 wounded persons were treated with Ilizarov method of bone segment transport. Among them, only one was female. Average age was 33 years. METHODS: The authors performed modified Ilizarov's method as standard procedure for bone segment transport in treatment of defect pseudoarthroses. After all soft tissues are held, corticotomy in metaphysis is performed and free bone segment transport started with Ilizarov method. Physical therapy provided adequate mechanical load, essential for bone healing and restoring the functionality of injured extremity. RESULTS: In the group of treated patients, the largest bridged defect was 20 cm, and the smallest one was only 1 cm. Infection arises in 20 of 60 patients. Contracture complications were ankle contractures, knee contractures and one elbow contracture. We also found one n. peroneus palsy and one limb amputation should be performed. DISCUSSION: Ilizarov method of bone segment transport presents the only procedure that could successfully and completely treat pseudarthroses, thus avoiding necessaries for limb amputations. Requirements in this procedure are experienced and highly qualified surgical team and high motivation and compliance of the patient.
Subject(s)
Ilizarov Technique , Pseudarthrosis/surgery , Adolescent , Adult , Arm Injuries/surgery , Female , Humans , Ilizarov Technique/adverse effects , Ilizarov Technique/instrumentation , Leg Injuries/surgery , Male , Middle Aged , WarfareABSTRACT
Perfect balance between maximal suture strength and minimal foreign-body reactivity guarantees success, using microsurgical techniques. The proposed initial locking knot allows optimal edge approximation. It has strength, it is simple to master, and is not too bulky. The knot is kept in its first position, without danger of slipping, before securing it with an additional knot of two loops. No additional knots are necessary, because the completed knot may fail by breaking, but never by slippage.
Subject(s)
Microsurgery/methods , Suture Techniques , Humans , Tensile StrengthABSTRACT
The shoulder is the most movable and the most unstable joint in a human body. The glenohumeral joint is particularly vulnerable because overhead activities put tremendous stress on its static stabilizers (ligamentous labral complex) and the dynamic stabilizers (rotator cuff muscles). Overhead activities may stretch or injure the static stabilizers. Minor aberrations in mechanisms controlling stability have a significant and cumulative effect on the shoulder biomechanics, and increase the risk of injury. Impingement syndrome and glenohumeral instability are predominant injuries affecting the shoulder.
Subject(s)
Cumulative Trauma Disorders , Shoulder Injuries , Biomechanical Phenomena , Cumulative Trauma Disorders/diagnosis , Cumulative Trauma Disorders/physiopathology , Cumulative Trauma Disorders/therapy , Humans , Shoulder Impingement Syndrome/diagnosis , Shoulder Impingement Syndrome/physiopathology , Shoulder Impingement Syndrome/therapy , Shoulder Joint/physiopathology , Tendinopathy/diagnosis , Tendinopathy/physiopathology , Tendinopathy/therapyABSTRACT
The recurrence of instability after arthroscopic stabilization has been significantly higher than after open repair. One of the reasons for the high failure rate is the inability of arthroscopic repairs to address the plastic deformity of the capsule that occurs in the glenohumeral ligament-labrum complex. The arthroscopic technique is used to repair the torn labrum to the glenoid, but without adequate tightening of the anterior capsule, which is successfully accomplished with an open technique. This report describes the new technique of arthroscopic Bankart repair with extracapsular and extra-articular knot using suture anchors that allows tightening of the anterior capsule sufficiently as with an open Bankart procedure.