Comparison of percutaneous and open repair of Achilles tendon rupture: results and complications from a single institution.

BACKGROUND: The Achilles tendon is the strongest tendon in the human body, but it is prone to injury, especially in modern times when recreational sports are growing in popularity. As a result, Achilles tendon rupture is becoming an increasingly common medical problem in modern society. The main objective of this study was to compare the outcomes of percutaneous repair and open repair for the treatment of Achilles tendon rupture. METHODS: A retrospective study was conducted involving a total of 316 patients who had undergone surgical treatment for Achilles tendon rupture between 2013 and 2021. The data collected from the medical history of these patients included the type of surgical procedure, the mechanism of injury, the age and sex of the patients, the time spent in the hospital, and any possible complications of the surgical treatment (such as infections, reruptures, or sural nerve injuries). RESULTS: The study revealed that there was no significant difference between percutaneous and open surgical approaches in terms of sural nerve injury. However, there was a statistically significant advantage of the percutaneous method in terms of the number of infections, which was significantly lower than that of the open method. Additionally, the median length of hospital stay was found to be four days longer with the open approach. However, the study noted that a statistically significant advantage of the percutaneous method for rerupture could not be established due to the small number of patients with rerupture and the insufficient ratio of patients with rerupture in relation to the size of the observed population. CONCLUSIONS: Percutaneous repair is an effective treatment option for Achilles tendon rupture and has outcomes equal to or better than those of open repair. Therefore, this approach is recommended as the preferred method of treatment due to the presence of fewer complications, provided that the indications for this technique are appropriate.

Surgical treatment of scapular fractures: Results and complications.

INTRODUCTION: The aim of this study was to describe a surgical technique and report on patient-based functional outcomes and complications following open reduction and internal fixation in patients with scapular fractures. METHODS: The study comprised 14 patients who were treated with open reduction and internal fixation (ORIF) of a scapular fractures between September 2010 and July 2018. Surgical indications were as follows: medial/lateral displacement greater than 20 mm; shortening greater than 25 mm; angular deformity greater than 40°; intra-articular step-off greater than 4 mm; and double shoulder suspensory injuries (including fracture of the clavicle, coracoid or acromion with displacement greater than 10 mm). All patients underwent X-ray examination (true AP, Y scapular view) and computed tomography (CT) scans. Fractures were classified according to the revised (AO/OTA) classification system. Functional outcomes were measured using Constant-Murley scores. RESULTS: Seven patients had glenoid fossa fractures, six patients had scapular body fractures and one patient had an acromion process fracture. All glenoid fossa and scapular body fractures were exposed via the Judet approach. Eleven of 14 patients were given Constant-Murley scores at the final follow-up examination; three patients were lost to follow-up. The mean follow-up after injury was 44 months (range, 6-92 months). We found infraspinatus muscle hypotrophy in four patients. The mean Constant-Murley score was 93.45 (±8.93) for the injured arm and 98.36 (±2.91) for the uninjured arm. The mean score between the injured and uninjured arm was 4.91(±6.49), which is an excellent functional outcome according to the Constant-Murley score. CONCLUSIONS: Open reduction and internal fixation of displaced scapular fractures is a safe and effective treatment option that results in a reliable union rate and good-to-excellent functional outcome.

Intramedullary nailing of adult forearm fractures: Results and complications.

INTRODUCTION: The aim of this study was to evaluate the clinical and radiological results of adult forearm fractures treated with interlocking intramedullary nailing. METHODS: This retrospective study included 21 patients who were treated with intramedullary interlocking nailing for forearm fractures between January 2010 and September 2017. All patients were treated with intramedullary forearm nails designed to allow interfragmentary compression. The medical records and radiographs of all patients were evaluated. Fractures were classified according to the AO/OTA classification system by analyzing the radiographs. Union time, union rate, clinical outcome, and complications were evaluated. RESULTS: Primary intramedullary osteosynthesis was performed in 17 patients with forearm shaft fractures. The average union time was 10 weeks (range, 8-16 weeks) in the primary osteosynthesis cohort. Secondary intramedullary osteosynthesis was performed in four patients following the removal of plates and screws due to nonunions. For this group of patients, bone union took an average of 17 weeks (range 8-24 weeks). The overall union rate was 95.24% in the 21 forearm fractures which were treated with an intramedullary interlocking nail with a compression screw that allows interfragmentary compression to be obtained. Overall complications included one nonunion, one postoperative rupture of the extensor pollicis longus tendon, and 1 postoperative transitory radial nerve palsy. CONCLUSIONS: Intramedullary interlocking nailing with a compression screw is an alternative method of fixation for treating adult forearm fractures and provides good clinical outcomes with reliable union rates.

TREATMENT OF HUMERAL SHAFT FRACTURES: ANTEGRADE INTERLOCKING INTRAMEDULLARY NAILING WITH ADDITIONAL INTERLOCKING NEUTRALIZATION SCREWS THROUGH FRACTURE SITE.

The aim of this study was to compare union time between two different nail designs for the treatment of humeral shaft fracture, i.e. antegrade interlocking intramedullary nail with and without additional interlocking neutralization screws. The retrospective study included 51 patients treated with antegrade humeral intramedullary nailing between January 2015 and December 2017. The inclusion criteria of the study were proximal and middle third humeral shaft fractures. Fifty-one patients met the inclusion criteria; 23 patients were treated with antegrade intramedullary nail with additional interlocking neutralization screws through fracture site (group A) and 28 patients were treated with antegrade intramedullary nail without additional interlocking neutralization screws (group B). Medical documentation and radiographic images taken preoperatively and postoperatively were reviewed. Radiological union was defined as cortical bridging of at least three of four cortices in two-plane radiographs, with disappearance of the fracture gap. There were no significant differences in union time between the groups (p>0.05). To our knowledge, this is the first report of antegrade interlocking humeral nailing with additional interlocking neutralization screws through fracture site. Hypothetical advantages of fracture gap reduction by additional interlocking neutralization screws to promote union were not confirmed by this first clinical trial.

Tibial plateau fracture management: arthroscopically-assisted versus ORIF procedure - clinical and radiological comparison.

INTRODUCTION: Tibial plateau fractures are articular injuries that may influence final functional outcome of the knee. Although these fractures comprise only 1% of all fractures, the fracture pattern is usually complex and requires anatomical reduction and absolutely stable fixation to achieve satisfactory results. The development of knee osteoarthritis is a common late complication and it can be strongly influenced by additional, underestimated cartilage defects, and meniscal and ligament tears. MATERIALS AND METHODS: Between January 2012 and February 2015, a total of 78 patients with tibial plateau fractures (Schatzker type I-III) were enrolled in the study. Patients were divided into two groups: one group was treated with arthroscopically-assisted reduction and internal fixation (ARIF) and the other with open reduction and internal fixation (ORIF). The final number of patients was 75; 40 in the ARIF group and 35 in the ORIF group. Radiography and computed tomography were used to assess fracture pattern. An immediate postoperative radiograph was performed, and then repeated at 6 weeks, and 3,6 and 12 months after surgery. Demographic data (age and sex), additional intraarticular injuries, hospital stay and complications were noted, and clinical and radiological Rasmunssen score at 3, 6 and 12 months after surgery were evaluated. RESULTS: Additional intraarticular lesions were found in 27 patients; 20 in the ARIF group and 7 in the ORIF group (p = 0.06). There was a statistically significant difference in average duration of hospital stay: 3.10 ± 0.63 days for the ARIF group and 5.51 ± 1.66 days for the ORIF group (p = 0.0001). All fractures healed within 3 months following surgery. The overall complication rate was 12%. There was no statistically significant difference in complication rate between the two groups (p = 0.63). Clinical and radiological scores were excellent in most patients in both groups. There was no statistically significant difference in average clinical and radiological Rasmunssen scores between the two groups. CONCLUSIONS: Both ARIF and ORIF can provide equally good results; however, ARIF seems to offer a more precise evaluation and treatment of associated intraarticular lesions and to reduce the duration of hospital stay.

Treatment of Periprosthetic Femoral Fractures after Total Hip Arthroplasty Vancouver Type B.

The rate of periprosthetic femoral fractures following total hip replacement has been growing steadily in the last 20 years and ranges from 0.1% to 2.1%. These fractures are mostly related to older patients with the presence of chronic diseases and frequently poor bone quality. The treatment is surgically very complex and demanding, followed by a series of complications. The evaluation in this retrospective study included 23 patients who were medically treated from January 2004 to December 2015 with the mean follow-up of 14.5 (range, 9-25) months. There were 17 patients with cement total hip arthroplasty (THA) and 6 with cementless THA. During treatment of fractures, different techniques were implemented including the use of wire cerclage, dynamic compression plates (DCP), a locking compression plate (LCP) system, and long revision stem. For the purpose of distinguishing fractures, we used the Vancouver classification by Duncan and Masri. For clinical evaluation, we used the modified Merle d'Aubigne score system and monitored complications during treatment. The aim is to show treatment results of the type B periprosthetic femoral fractures by using different operative treatment techniques. According to the Vancouver classification within type B, 10 (43.47%) patients had type B1 fractures, another 10 (43.47%) patients had type B2 fractures, and three (13.04%) patients had type B3 fractures. According to gender distribution, there were eight (34.8%) male and 15 (65.2%) female patients, mean age 59.5 (range, 47-86) years. Twelve (52.2%) and 11 (47.8%) patients had left- and right-sided fractures, respectively. The mean length of hospital stay was 16 (range, 9-26) days. According to the Merle d'Aubigne score system, 10 patients with type B1 fractures had the mean score of 11.5 points, which is poor result. Poor result was also recorded in patients with type B2 fractures, with the mean score of 10.6 points. The three patients with type B3 fractures had the mean score of 12 points, which is considered fair score. In conclusion, Vancouver classification has been widely accepted and using the protocols makes decision making during treatment much easier. During treatment of this type of fracture, we used various implants, wire cerclage, DCP and LCP, as well as long stem revision. In certain cases, we applied surgical techniques, implants that are not recommended by the Vancouver protocol by which we treated periprosthetic femoral fractures; in these case, we recorded nonunion bone, malunion and breaking of implants, which resulted in poor treatment outcome.

HUMERAL NAIL: COMPARISON OF THE ANTEGRADE AND RETROGRADE APPLICATION.

Application of humeral nail in the treatment of humeral shaft fractures is a relatively novel method of fracture fixation. Its application at Clinical Department of Traumatology, Sestre milosrdnice University Hospital Center began in 2001. The operative procedure should be performed using a minimally invasive technique without fracture opening in order to maintain optimal conditions for fracture healing including hematoma management. However, in everyday practice it is often impossible to obtain satisfactory fracture reduction using the closed procedure, so open reduction and additional fixation with wires or screws are mandatory. Over the last 14 years, fixation of fractures with the locking nail was performed in more than 400 patients. Cases of pseudarthrosis and pathological fractures were also managed successfully. There were more female patients. The mean time from injury to surgery was 2.4 days. Surgery was performed immediately upon admission to the emergency service whenever possible. This study comprised 234 patients with humeral shaft fractures treated with the humeral nail (antegrade insertion was applied in 103 and retrograde in 131 patients). The aim of the study was to stress out the complexity of appropriate operative treatment of humeral shaft fractures using intramedullary fixation, as well as the importance of proper reduction and stable fixation.

Reverse shoulder prosthesis: implementation and experience in Croatia.

Reverse shoulder prosthesis has become one of the most often used prosthetic implants in shoulder replacement surgery. It has a wide spectrum of indications, starting from comminuted humeral fractures and posttraumatic arthritis to arthritis caused by the rotator cuff loss. Its application at our hospital began in 2004, at first in few specific cases and with time in ever growing number of patients. Over 8 years, more than 250 reverse shoulder prostheses were implanted at our institution. In addition, our surgeons supervised its application in other hospitals all over Croatia. In the postoperative course, the shoulder was immobilized for 4-6 weeks with a thoracobrachial cast. After removal of the cast, physical therapy was initiated. The length of physical therapy program depended upon many factors. As a rule, immobilization lasted longer in patients that were operated on due to posttraumatic arthritis and those that suffered from deltoid muscle atrophy and shoulder contracture before surgery. Complications included dislocation of the prosthesis shortly after surgery (in the first four weeks) and infection. Infection was a special problem and treatment included even explantation of the prosthesis.

Ski helmets could attenuate the sounds of danger.

OBJECTIVE: To determine whether a ski helmet reduces skiers' hearing particularly sounds that can warn skiers of potentially dangerous situations. DESIGN: Randomized repeated measures (first part), environmental field measurements (second part). SETTING: Audiology Centre of Rijeka Medical School, ski slopes at Platak resort. PARTICIPANTS: Thirty healthy subjects not used to wearing a helmet each served as their own control. INTERVENTION: Ski cap, ski helmet, and no intervention in randomized order. MAIN OUTCOME MEASUREMENTS: Laboratory open-field audiometric testing: bareheaded, ski cap, and ski helmet (0.125-8 kHz protocol), and environmental A-weighted sound measurements on the slope for potentially dangerous situations like snowboarder breaking or skier passing by. In both parts of the study, the sound pressure levels (dB) and sound spectrum frequencies were analyzed. RESULTS: First part-No differences were found between bare head and wearing only a ski cap. Significant sound attenuation characteristics of the helmet were determined for frequencies 2, 4, and 8 kHz (P < 0.001). Second part-High sound pressure levels were found for all the danger sounds measured on the slope, especially at frequencies that were most affected by helmet sound attenuation (2-8 kHz) in previously conducted laboratory tests. CONCLUSIONS: Helmets could influence the level of the hearing threshold in frequencies between 2 and 8 KHz. The spectrum of danger sounds on the slope has high pressure levels at frequencies that were most affected by helmet sound attenuation characteristics (2-8 kHz), so the helmet wearers might misinterpret the sounds of potentially dangerous situations because the sound might be distorted.