The impact of postoperative pain on early ambulation after hip fracture.

Hip fractures are the most serious consequence of falling in older people with osteoporosis. Early ambulation is one of the main goals of inpatient rehabilitation aimed at reducing negative effects of immobilization, and promoting functional recovery. Recognizing the role of different factors that are associated with time to ambulation time after hip fracture surgery may help decrease morbidity and mortality rates. The aim of this study was to examine the impact of postoperative pain time to ambulation following hip fracture surgery. A total of 96 patients who consecutively presented at the Clinic for Orthopaedic Surgery and Traumatology, Clinical Center Serbia during a 6 month period were included in the study. Subjects were assessed regarding socioedemographic characteristics, prefracture functional status, cognitive status, general health status, fracture type, type of anaesthesia, and waiting time for surgery. The VAS scale (0-100) was used to measure pain intensity on the first postoperative day. Our results revealed that patients, whose time to ambulation was = 48 h postoperatively were of worse physical health, and had significantly higher VAS score on the first postoperative day. Unrelieved pain in geriatric hip fracture patients is associated with delayed ambulation. Future research should confirm the posi-tive effects of aggressive pain management programs on early functional outcome in elderly patients who sustain hip fractures.

Solitary lymph node metastasis without local recurrence of primary chordoma.

Chordoma is a malignant neoplasm believed to arise from notochord remnants. Its incidence is highest in the sixth decade and is generally regarded as a locally aggressive tumor with slow progression growth rate. Its metastatic incidence ranges from 5 to 40%, and it is generally believed that metastases without local recurrence of primary neoplasm are extremely rare. We report a case of a 38-year-old male patient with solitary inguinal lymph node metastasis without local recurrence of a previously surgically treated primary sacrococcygeal chordoma.

Our first experience with extended proximal femoral osteotomy for revision hip surgery.

INTRODUCTION: The extended proximal femoral osteotomy (EPFO) is a demanding but useful technique for revision of both cemented or noncemented femoral components. MATERIALS AND METHODS: Between 2000 and 2004 we performed extended proximal femoral osteotomy (EPFO) in 25 cases during revision hip surgery. The main indication for doing revision surgery was aseptic loosening of both total hip arthroplasty (THA) components (18 patients), whilst in the remaining 7 patients the indications were: aseptic loosening of acetabular component in three patients, septic loosening of THA in two patients, recurrent dislocation of the THA because of incorrectly positioned femoral component in one patient and aseptic loosening of cemented hip hemiarthroplasty in one patient. RESULTS: There were 14 women and 11 men. The mean follow-up was 22 months. The average time to revision was 8.3 years. The mean age at the time of revision was 70.3 years (range 55 to 81). At the time of the last control examination all osteotomy sites had healed with signs of remodelling. The mean time to union ranged from 11 weeks to 6 months, shown by the bridging callous formation in both radiographic projections. Bone remodelling occurred in all patients by 12 months and no complications such as nonunion, excessive fragment migration or wire breakage were found. CONCLUSION: In our experience, the extended proximal femoral osteotomy when properly indicated represents an efficient and reliable technique in revision hip surgery.

[Digital video technology in orthopedics].

Digital video technologies are new and powerful tools with wide applications in orthopaedics. Already integral to several common medical devices, digital images can be used for case documentation and presentation as well for diagnostic and surgical patient care information. Digital technologies allow easy manipulation of photographic, video and graphic materials in ways that were impossible with conventional techniques. Educational presentation has been transformed by use of computers and digital projectors. Understanding the basic foundations of digital imaging technology is important for effectively creating digital images, videos and presentations. In this review, we are going to discuss some of the issues that are raised by digital imaging in orthopaedics, digital image processing, as well as, we are giving some recommendations for good quality of pre-, post- and intra-operative photographs in clinical use.

[Functional and radiographic results in partial unipolar hip joint arthroplasty after 6-15 years].

Due to extreme conditions during civil war in early 1990's we were forced to deviate from accepted guidelines in treatment of intracapsular fractures of the femoral neck. Therefore, majority of patients were treated non-operatively. In those that were subjected to surgery, unipolar hemiarthroplasty was treatment of choice, since conditions permitted us to attempt osteofixation in very few, youngest of our patients. As a result of this practice born of necessity, we can now look back and learn from this unique experience.

[Principles and new methods of flexible fixation of fractures of long bones]. / Aktuelni principi i neke od novih metoda fleksibilne fiksacije preloma dugih kostiju.

The modern developments in orthopedic traumatology brought various modifications of modes and principles in operative fixation of fractures. Contrastingly to previous concept of rigid fixation as a priori necessary element for complete fracture union, a principle of flexible or elastic fixation took an equal place in contemporary professional doctrine. The results of these changes were technological innovations of fixation implants, with their mechanical characteristics as a base for their biological application that promoted essential advancements in fracture treatment and full functional recovery of injured patients. We review in this paper the modern principles and some new implant generations in flexible fracture fixation.