Thalassemia major. A report of two cases with severe skeletal involvement.

Beta thalassemia major is rare in Serbia. Previously incurable, affected patients now live to adulthood with regular blood transfusions. The improvement in supportive treatment over recent decades has given rise to many more patients suffering from the associated metabolic complications of anaemia and iron overload, such as osteopenia and other skeletal changes. We present two patients with severe beta thalassemia major from early childhood, who encountered pathological long-bone fractures during the clinical course of their disease. One suffered a distal femoral diaphyseal fracture, and the second a distal tibia fracture. Both fractures occurred in osteopenic bone and were managed non-operatively due to the patients' general medical condition. Despite intense medical intervention, both patients died from disease progression within one year of their fractures, aged 23 and 24 years. As life expectancy rises it is anticipated that an increased number of beta thalassemia major patients will suffer pathological long-bone and other osteoporotic fractures. These fractures appear to both herald and contribute to a general clinical deterioration of this disease. Advances in stem-cell technology may hold the key for a definitive cure.

[Richard von Volkmann, one career of orthopaedic surgeon and poet].

Richard von Volkman was one of the most famous and important surgeons in the 19th century. He pioneered antiseptic procedures and was especially known for his achivements in orthopedic surgery. Von Volkmann was born in Leipzig, Germany and attended medical schools in Giessen, Halle, and Berlin. Starting in 1867, he worked as a professor of surgery at the University of Halle, also leading its surgical clinic. He was active as a surgeon during Seven Weeks' War with Austria in 1866 and the Franco-Prussian war 1870/1871, in the latter as consulting Generalarzt. He was important in the introduction of antiseptic wound treatment in Germany, and through it to the United States of America. Two observations in orthopaedic surgery bear his name to these days: Volkmans contracture and Heuter-Volkmans low. Volkmann also wrote poetry under the name Richard Leander and his book entitled "Dreams by French Firesides" which still has a place in literature. He died of paralysis due to a chronic spinal disease, following a prolonged illness, in the Binswanger institution in Jena in 1889, at the top of his careere.

[History of orthopedic surgery in Belgrade--100 years of orthopedics in Serbia (1905-2005)].

The history of orthopedics in Serbia is related to a hand x-ray made in 1905 by dr. Nikola Krstic. The first orthopedic word was founded in 1919, to be enlarged into a full-fledged orthopedic surgical ward of the General State Hospital in 1932. Until 1941, the ward headed by Dr. Nikola Krstic. The Orthopedics course was headed by Dr. Borivoje Gradojevic, who also wrote the first textbook in our country in 1934. In 1947, the ward became the Clinic for Orthopedic Surgery and Traumatology in Belgrade which is the orthopedic basis of Serbia, together with the Special Orthopedic Surgery Hospital Banjica, even today.

[Modern aspects of shoulder injury treatment].

The article describes injuries of soft and bone structures of the shoulder region, with special emphasis on the following clinical forms: instabilities and luxations of the glenohumeral joint, fractures of the proximal humerus, clavicle and the states of painful shoulder. Fractures and dislocations, but also significant entities - painful states caused not only by fractures but also by minor trauma such as tendinitises and m.supraspinatus tendon and bicipital tendon ruptures are discussed in more detail. Moreover, their consequences - painful and stiff shoulder - as well as modern diagnostic and therapeutic procedures applied in the painful shoulder treatment are also discussed.

[Nonoperative treatment of fractures of the base of the first metacarpal bone--Bennett fracture].

Although described as early as in 1882, the fracture of the metacarpal bone basis is still a therapeutic challenge for first orthopedic surgeons. Several non-operative and operative methods in the treatment of this fracture have been described. The goal of this paper is to analyze nonoperatively treated patients with Bennett's fracture. A group of 50 patients of both sexes, with the fracture of the first metacarpal bone basis fractures and with the average follow-up of 9 (6-13) years, has been analyzed. After an orthopedic reposition, immobilization lasting 5 weeks was applied, followed by a physical therapy in the duration of 4 to 8 weeks. Numerically, according to Steel, both the subjective and objective state of the hand, as well as an x-ray finding, were assessed. The total hand function was excellent and good in 42 patients, satisfactory in 8, and none of the patients had unsatisfactory function of the hand. Regardless of present degenerative changes, the function of the hand was good, especially if reposition with fragment dislocation less than 2 mm was achieved.

[Implementation of the radiolabelled antibiotic in the detection of orthopedic infections].

The aim of the study is detection and evaluation of the orthopedic infections using 99mTc-ciprofloxacin, radiopharmaceutical supposed to distinguish inflammation from infection. There were 15 true positive findings, 9 true negative, and two were false positive, while 1 was false negative. Sensitivity was 94%, specificity 82%, positive predictive value 88%, negative predictive value 90% and accuracy 89%. According to our results, scintigraphy with 99mTc-ciprofloxacin is a useful method for detection and assessment of exact localization of orthopedic infections, which might be useful for (differential) diagnosis, surgical treatment in due time as well as monitoring of the treatment of conservative therapy.