Anterolateral minimally invasive hip approach offered faster rehabilitation with lower complication rates compared to the minimally invasive posterior hip approach-a University clinic case control study of 120 cases.

INTRODUCTION: The surgical approach used in total hip arthroplasty (THA) has been identified as a factor affecting the outcome. In our University Hospital, the posterior surgical approach is the gold standard. The Rottinger approach is an anterolateral approach which is truly minimally invasive, as it does not vertically cut any muscle fibers. The objective of this study was to determine the difference in surgical outcomes between the posterior hip approach and the Rottinger approach which was newly adopted at our Hospital. METHODS: In a retrospective study, a total of 120 patients underwent THA; 60 patients using the Rottinger approach by the young consultant surgeon and another 60 patients using the standard posterior approach by the senior orthopaedic surgeon. Patients have been controlled for age, gender, and ASA grades. All preoperative demographic data showed no significant difference between the control and study groups. The following parameters were analyzed: incision length, duration of the surgery, intraoperative blood loss, WOMAC index, Harris Hip Score, range of motion at 3 and 12 months after surgery, time of quitting the crutches, and willingness for the contralateral hip arthroplasty. RESULTS: WOMAC index, surgical time, and incision lengths have been without significant difference in both approaches. Intraoperative blood loss was significantly lower in the Rottinger group (CI: - 10.903, - 0.064). Harris Hip score was significantly higher (CI: 4.564, 12.973) in the Rottinger group at 3 months, but similar (CI: - 3.484, 2.134) at 12 months follow-up. At 3 months, active flexion and extension were significantly higher in the Rottinger group (CI: 0.595, 8.239; 2.487, 4.480, respectively), and active abduction and passive adduction (CI: - 5.662, - 0.338; - 6.290, - 1.410, respectively) in the posterior approach group. Patients in the Rottinger approach group on average quit crutches 3 weeks earlier and had no postoperative dislocations compared to 2 dislocations in the control group. CONCLUSION: The Rottinger approach offered faster rehabilitation with less need for crutches and with lower complication rates.

Treatment of peritrochanteric fractures by the use of gamma nail.

The Gamma nail was designed to treat unstable intertrochanteric and subtrochanteric fractures. In this study we analysed a total of 60 patients (44 men and 16 women), who were surgically treated for the peritrochanteric fracture in period 2006-2007 at the University Hospital Mostar. After the surgical treatment good bone healing was achieved in 50 patients (83.3%). A total of five patients had delayed healing or protrusion of the cervical screw, and in two patients nails were not appropriately distally locked. During the follow-up period a total of 7 patients died. The average operation time was 40 minutes, and the average blood loss was 400 mL, which is a comparable result with the previously published studies. In conclusion, although most of the peritrochanteric fractures treated at the University Hospital Mostar were fixated by gamma nail, the final decision regarding the operational technique should be left to surgeon's judgment, since the efficacy of the treatment plan is highly dependent on experience of the operational team and surgeon's operational technique.

Bone fractures in a 53-year-old patient with parathyroid adenoma--a case report.

The study reports a case of primary hyperparathyroidism in a middle-aged patient who was first admitted for persistent ankle pain and local swelling. The subsequent clinical procedures suggested cystic changes in several leg bones, which were later shown to be caused by the parathyroid adenoma. Clinical presentation of the primary hyperparathyroidism can be highly misleading, sometimes causing various clinical procedures before it is certainly diagnosed.

Open reduction of congenital hip dislocation by medial approach: case series.

AIM: To present the results of medial approach in open reduction of congenital hip dislocation, with the preservation of the medial femoral circumflex artery. METHODS: We operated on 48 nonreducible hip dislocations diagnosed in children aged 6-27 months. Twenty-two hips (17 patients) were available for clinical and radiographic follow-up. The median age of children at the time of operation was 15 months (range 7-29), and median duration of the follow-up was 4.5 years (range 3-14). The latest radiographic evaluation of the treatment outcome was based on Severins classification. RESULTS: There were three hips with the loss of concentric reduction. Osteochondritis developed in three, and coxa magna in seven hips. On final evaluation, 19 hips were rated as excellent or good (Severin I or II), and three hips as poor (Severin III or IV): one hip with evident ostechondritis lesions, and two hips with the loss of concentric reduction due to treatment discontinuation. CONCLUSION: By preserving circumflex medial artery and eliminating obstacles to reduction, vascularization of the femur head is ensured. The loss of concentric reduction is prevented by complete removal of all obstacles on the way of the femur head down to the bottom of acetabulum, by postoperative cast immobilization, and by walking with abduction orthosis for an appropriate period of time. Medial approach in surgical management of congenital hip dislocation in infants under 24 months of age is considered safe and efficient procedure.