Recurrent posterior dislocation following primary posterior-stabilized total knee arthroplasty.

In our series of 136 patients with primary total knee arthroplasty using posterior-stabilized prosthesis, a female patient with Parkinson disease developed posterior dislocation of the knee 9 months after surgery. Eventually, the dislocation became recurrent, occurring several times a day. The patient made the reposition always by herself. Two months after the first dislocation, we performed the revision of the polyethylene tibial insert and found wearing of the tibial insert's cam as an hitherto unreported cause of the mechanical instability of the total knee prosthesis.

[Results of treatment of hip joint prosthesis-related infections]. / Nasi rezultati lijecenja inficiranih endoproteza kuka.

The article present results of the operative treatment of deep infections in the hip joint prostheses. Ninetieth patients treated from 1980 through 1998 were analysed. Gram-positive organisms were found in 65% of the cases and gram-negative in 35%. Staphylococcus aureus were isolated in 50% of the cases. The two-stage reimplantation procedure is performed in four patients. Excellent results were reported in three patients, and poor results in one patient. The Girdlestone pseudarthrosis as a definitive procedure is performed in fifteen patients. Good results were reported in two patients, fair results in twelve, and poor results in one patient. The mean shortening of the limb was 4.5 cm. The infection were controlled in 93% of the cases. Better functional results are obtained by the two-stage reimplantation than the Girdlestone pseudarthrosis, though is an acceptable method of controlling infection.

[The treatment of Dupuytren's contracture by partial fasciectomy]. / Lijecenje Dupuytrenove kontrakture djelomicnom fascijektomijom.

The authors present their own experience in the treatment of Dupuytren's disease. From 1977 until 1991, 102 patients were treated with partial palmar and digital fasciectomy. Postoperative complications occurred in 16 (15.68%) cases: infection in 1 (0.98%), skin necrosis also in 1 (0.98%), hematoma in 6 (5.88%) and postoperative stiffness of the hand in 8 (7.84%). Excellent postoperative results were reported in 61 patients (59.8%), good results in 37 (36.3%) and poor results in 4 (3.9%). Twenty-three patients were followed-up. There were 9 recurrences (39.1%) and 11 extensions of the pathologic process (47.8%). In summary, we feel Dupuytren's contracture can be controlled and the patient's hand function can be improved by partial fasciectomy.

[Treatment of femoral neck fractures with bipolar hemiarthroplasty]. / Lijecenje prijeloma vrata femura bipolarnom hemiartroplastikom.

The aim of the study was determine the effectiveness of treatment with bipolar prosthesis in elderly patients with the femoral neck fractures. Patients admitted from 1980 through 1994 were analysed. Over this period, a total of 152 hip joint bipolar prostheses were implanted. Postoperative complications occurred in 9.2% of cases (luxations of endoprostheses 2.63%, loosening of the femoral component 1.31%, infections 2.63%, intrahospital mortality 1.31%, fractures of the endoprosthetic stem 0.65% and fracture of the polyethylene cup 0.65%). Ten (6.5%) hips required revision surgery. Twenty eight patients were followed-up. Excellent results were reported in twenty-three patients (82.1%), good results in four (14.3%), and fair results in one patient (3.6%). There were no poor results. In summary, we feel that bipolar hemiarthroplasty is the method of choice in elderly patients with femoral neck fractures.

[Results of surgical treatment of congenital muscle torticollis]. / Nasi rezultati kirurskog lijecenja prirodenog misicnog tortikolisa.

The article present results of the operative treatment of congenital muscular torticollis at the Department of Orthopaedics, Clinical Hospital Split from 1950 to 1995. 197 patients were operated and in 1995 50 patients responded for the follow-up. Our results confirm that the best results are obtained by open distal tenotomy of the sternocleidomastoid muscle after the first year of life. Children older than six years need bipolar tenotomy, and the results are poorer than in those operated in the first six years of life.

Primary wound closure in war amputations of the limbs.

We have reviewed 75 amputees, 58 in the lower limb and 18 in the upper. Closed amputation was performed in 69 patients (92%) and an open procedure in six (8%). Wound infection occurred in six (8%) and one patient died from thromboembolism. Wound healing was normal in the remainder. The results of closed amputation in war conditions are very good, if performed within 6 hours of injury.

War injuries to the extremities.

AIM: The authors present their own experience in the treatment of war injuries to the extremities during the war in Croatia and in Bosnia and Herzegovina. METHOD: From November 1991 until April 1994, 186 patients with war injuries to the extremities were treated. Treatment began with first aid offered at the battlefield, followed by transport of patients to war hospitals, and transfer of the most severe cases to the rear hospital (Split University Hospital). RESULTS: Isolated injuries to the extremities were present in 155 patients (83%), 38% of them with injuries to soft tissues of the extremities and 62% with both soft-tissue injuries and bone fractures. Associated minor injuries to the other parts of the body were present in 31 patients (17%). Amputation of the extremity was performed on 22.5% of the patients. All fractures were treated by external fixation, whereas soft-tissue lesions were managed by debridement and excision of the damaged tissue, with compulsory antibiotic and antitetanic therapy. The rates of mortality and infection were 0.5 and 6.4%, respectively. CONCLUSION: Our experience emphasizes the importance of field hospitals in timely and adequate treatment of war wounds to the extremities. Treatment of the wound by a trained professional within 2 hours after wounding saved many lives and extremities. The patients were only rarely referred to the rear hospital.

[Personal results in the surgical treatment of pertrochanteric fractures]. / Nasi rezultati kirurskog lijecenja pertrohanternih prijeloma.

Trochanteric fractures of the femur are frequent in elderly people. This region is well vascularised and shows a tendency to heal rapidly. Surgical procedure is the method of choice in the treatment of these fractures. The study comprised two groups of patients. The first group of 40 patients received surgical treatment from 1971 to 1982, and the second one from 1985 to 1993. The results were evaluated on the basis of clinical and radiological criteria. Good to excellent results were found in 85 percent, and poor results in 15 percent in the first group. In the second group, good to excellent results were found in 92 percent, and poor results in 8 percent. The results in the second group were significantly better compared to those in the first group. Our results are in accordance with those reported in literature. We calculated Z-values by groups. Z-values were 1.18, 0.02 and 0.71 for excellent, good and poor results, respectively (P > 0.05).

[Incidence of congenital hip dislocation in Lastovo 1885-1993]. / Ucestalost prirodenog iscasenja kuka na Lastovu od 1885. do 1993. godine.

This study was designed to determine the incidence of congenital dislocation of the hip on the island of Lastovo in the period from 1885 to 1993. There was a total of 19 infants with congenital dislocation of the hip out of the 3676 babies who were born alive. The overall incidence accounted for 5.2/1000 live births. Our findings demonstrated that a high incidence of the disease (57.9%) was strongly correlated to a positive family history. In the majority of cases, the diagnosis of congenital dislocation of the hip was established in the walking age. From 1960, children are born in the maternity hospitals, and the disease is consequently discovered and treated earlier.

[Treatment of gigantocellular tumors of the bone in our department]. / Lijecenje gigantocelularnog tumora kosti na nasem odjelu.

Thirty-four patients with giant cell tumor of bone were followed up at the Department of Orthopedics, University Hospital Firule, Split from 1960 to 1989. The age and sex distribution of patients and the location of tumors reported in this study are similar to those presented in the majority of large series. Thirty patients were treated with surgery and four with irradiation only. A significant correlation was observed between therapeutic procedures and recurrence of tumors. The incidence of local recurrence was 14.7%. The metastatic lesions in the lung were present in 26.5% of the patients. The most successful therapies for giant cell tumors are excision or resection "en bloc" and cancellous bone grafting. The authors recommend radical resection of tumors.

[Conservative treatment of the painful, stiff shoulder]. / Konzervativno lijecenje bolnog, odnosno ukrucenog ramena.

The painful respectively stiff shoulder form an important part of orthopaedic practice. The treatment of patients with such a disease is at first always conservative except acute rupture of the tendon. Recurrences and those who do not respond to therapy require surgery. This study includes 86 patients treated for the painful shoulder. The were followed up and subjected to statistical analysis to determine the success of treatment by conservative methods. Conservative methods were in 83 shoulders, what amounts to a rate of 93 percent. Our results correspond to those reported in literature.

[Treatment of femoral neck fractures with endoprostheses in the aged]. / Lijecenje prijeloma vrata bedrene kosti endoprotezom u starijih.

A primary prosthetic replacement is advocated for all elderly patients with displaced fractures of the femoral neck. The aim of the study was to determine the effectiveness of this method of treatment. Patients admitted to the Department of Orthopedics, University Hospital Firule, Split, from 1977 through 1989 were analyzed. Over this period, a total of 350 hip joint endoprostheses were implanted (233 hemiarthroplasties, 38 total hip arthroplasties and 79 biarticular endoprostheses). Postoperative complications occurred in 10.85% of cases [infections (1.43%), luxations of endoprostheses (4.28%), loosening of the femoral component (2%), intrahospital mortality (1.43%), perforations of the femur (0.86%), lesions of the sciatic nerve (0.57%) and fractures of the endoprosthetic stem (0.28%)]. Fifty patients were followed. Using the clinical and radiologic criteria, functional results were evaluated. Excellent results were reported in thirty-seven (74%), good results in eight (16%), and poor results in five patients (10%). All arthroplasties carry a certain risk which could be diminished by the improvement of both fundamental characteristics of endoprostheses and surgical techniques. In summary, we feel this is the best method to be utilized in elderly patients with the femoral neck fractures.

[Arthrodesis of the lower leg joint in posttraumatic deformity and arthrosis]. / Artrodeze gornjega noznog zgloba kod posttraumatskih deformacija i artroza.

Post-traumatic deformations and post-traumatic osteoarthritis of the ankle joint are treated by arthrodesis. The aim of this work was to determine the effectiveness of this method of treatment. Between January 1976 and December 1987, the patients controlled were treated at the Department of Orthopaedics, University Hospital Centre, "Firule", Split. On the basis of clinical and radiological criteria, the functional results were evaluated. In this period, a total of 20 patients were treated. All the patients had returned to their pre-injury work within 3-6 months. Excellent results were reported in fourteen (70%) and good results in 6 patients (30%). Today, in a time of great technological progress, when various endoprosthetic replacements for joints are available, arthrodesis of the ankle joint, although a non-physiological procedure, is still the best method of treatment of post-traumatic deformations and post-traumatic osteoarthritis of the ankle joint.