A retrospective study of antibiotic prophylaxis value in surgical treatment of lower limb fracture.

BACKGROUND: Surgical site infections (SSI) are nosocomial infections that cause considerable problems in orthopaedic surgery. Antibiotic prophylaxis can be used to reduce the risk for SSI. There is no universal antibiotic that can be recommended for prophylaxis in terms of coverage of all possible pathogens because of antibiotic resistance, and there are no universal recommendations for different types of patients in terms of injury type, selected operation and risk factors for development of SSI. The aim of this study was to analyse the effectiveness of antibiotic prophylaxis in surgical treatment (ORIF) of closed lower limb fractures in young, healthy patients. PATIENTS AND METHODS: Patient details were collected from the patient histories. Inclusion criteria for participants were age 20-30 years, not suffering from any type of chronic disease or state that may affect postoperative infection and ISS≤9. Antibiotic prophylaxis use and outcome (SSI) were compared between two groups of patients. Data were analysed using descriptive statistics, Fisher's exact test and t-test for proportions. RESULTS: A total of 347 patients with closed lower limb fractures treated with ORIF met the inclusion criteria. There were 290 male and 57 female patients, with an average age of 24.47 years. Prophylactic antibiotics were given to 242 patients (69.74%); 2g ceftriaxone was administered to 88.02% of the patients who received antibiotic prophylaxis. Ten patients developed postoperative infection (eight out of 242 with antibiotic prophylaxis and two out of 105 without antibiotic prophylaxis). The difference between the two groups was not statistically significant (Fisher's exact test, P=0.749). CONCLUSION: Antibiotic prophylaxis was ineffective in preventing SSI in patients with no risk factors for SSI who were undergoing ORIF for closed lower limb fractures.

Tension plate for treatment of olecranon fractures: new surgical technique and case series study.

BACKGROUND: Our aim was to determine the effectiveness of a new surgical technique for olecranon fractures using a tension plate (TP) designed by the operating surgeon. METHODS: We included patients with olecranon fractures treated between September 2010 and August 2013 in our study. Treatment involved a new implant and operative technique, which combined the most favourable characteristics of 2 frequently used methods, tension band wiring and plate osteosynthesis, while eliminating their shortcomings. The new method was based on the newly constructed implant. RESULTS: Twenty patients participated in our study. We obtained the following functional results with our TP: median flexion 147.5° (interquartile range [IQR] 130°- 155°), median extension 135°/deficit 10° (IQR 135°-145°), median pronation 90° (IQR 81.3°-90°), median supination 90° (IQR 80°-90°). Implant-related complications were noted in 1 patient, and implants were removed in 3 patients. The mean functional Mayo elbow performance score was 94.8 (range 65-100). The removal of the implant was considerably less frequent in patients operated using the new method and implant than in patients operated using conventional methods at our institution (p < 0.001). Mean duration of follow-up was 8 months. CONCLUSION: Our TP for the treatment of olecranon fractures is safe and effective. Functional results are very good, with significantly decreased postoperative inconveniences and need to remove the implant. Less osteosynthetic material was used for TP construction, but stability was preserved.

CONTEXTE: Notre but était de déterminer l'efficacité d'une nouvelle technique chirurgicale de réduction des fractures de l'olécrâne à l'aide d'un système à plaque et broches (SPE), conçue par le chirurgien pratiquant l'intervention. MÉTHODES: Nous avons inclus dans notre étude des patients victimes d'une fracture de l'olécrâne traités entre septembre 2010 et août 2013. Le traitement reposait sur un implant et une technique chirurgicale d'un genre nouveau, réunissant les caractéristiques les plus utiles de 2 méthodes d'ostéosynthèse couramment employées, soit le brochage-haubanage et la pose de plaque, tout en permettant d'en éviter les inconvénients. La nouvelle méthode a recours à un implant de conception nouvelle. RÉSULTANTS: Vingt patients ont participé à notre étude. Nous avons obtenu les résultats fonctionnels suivants avec notre SPE : flexion médiane 147,5° (écart interquartile [ÉIQ] 130°­155°), extension médiane 135°/déficit 10° (ÉIQ 135°­145°), pronation médiane 90° (ÉIQ 81,3°­90°), supination médiane 90° (ÉIQ 80°­90°). Des complications liées à l'implant ont été notées chez 1 patient et les implants ont été retirés chez 3 patients. Le score fonctionnel moyen à l'échelle MEPS (Mayo elbow performance score) a été de 94,8 (entre 65 et 100). Les retraits d'implant ont été nettement moins fréquents chez les patients soumis au nouveau type d'intervention et implant que chez les patients soumis aux méthodes d'intervention classiques dans notre établissement (p < 0,001). Le suivi moyen a été de 8 mois. CONCLUSION: Notre SPE pour le traitement des fractures de l'olécrâne est sécuritaire et efficace. Les résultats fonctionnels sont très bons et s'accompagnent d'un nombre significativement moindre de complications postopératoires et de retraits d'implants. La construction de cette SPE a nécessité moins de matériel d'ostéosynthèse, mais la stabilité a été préservée.

Subbrachial approach to humeral shaft fractures: new surgical technique and retrospective case series study.

BACKGROUND: There are few surgical approaches for treating humeral shaft fractures. Here we present our results using a subbrachial approach. METHODS: We conducted a retrospective case series involving patients who had surgery for a humeral shaft fracture between January 1994 and January 2008. We divided patients into 4 groups based on the surgical approach (anterior, anterolateral, posterior, subbrachial). In all patients, an AO 4.5 mm dynamic compression plate was used. RESULTS: During our study period, 280 patients aged 30-36 years underwent surgery for a humeral shaft fracture. The average duration of surgery was shortest using the subbrachial approach (40 min). The average loss of muscle strength was 40% for the anterolateral, 48% for the posterior, 42% for the anterior and 20% for the subbrachial approaches. The average loss of tension in the brachialis muscle after 4 months was 61% for the anterolateral, 48% for the anterior and 11% for the subbrachial approaches. Sixteen patients in the anterolateral and anterior groups and 6 patients in the posterior group experienced intraoperative lesions of the radial nerve. No postoperative complications were observed in the subbrachial group. CONCLUSION: The subbrachial approach is practical and effective. The average duration of the surgery is shortened by half, loss of the muscle strength is minimal, and patients can resume everyday activities within 4 months. No patients in the subbrachial group experienced injuries to the radial or musculocutaneous nerves.

An unusual cause of the ileus: non-specific stenosing ulceration of the small intestine.

Non-specific ulcerations of the small intestine are very rare. The cause and pathogenesis of these lesions remain obscure. The diagnosis of primary ileal ulcer is commonly overlooked and infrequently is established intraoperatively. Here we described a case of a 73-year-old woman who was presented to the emergency surgical department with the five days history of vomiting, distension, constipation, and abdominal pain. On physical examination abdomen was mildly distended and diffusely painful on palpation. Bowel sounds were present and active. Plain abdominal x-ray film showed ileus of the small intestine. Multislice computed tomography showed stenosing process of the ileum. Patient underwent exploratory laparotomy. Approximately 60 cm from the ileocecal valve ileum was inflamed and hypertrophic with a point of obstruction. Grossly, it appeared as a small intestine carcinoma. Involved segment of ileum including the point of obstruction was resected. Pathological examination showed ulceration of the ileum. After the surgery the patient made rapid recovery and was discharged from the hospital on the tenth postoperative day.

Hemiarthroplasty is an effective surgical method to manage unstable trochanteric fractures in elderly people.

Trochanteric femoral fractures are a major problem in the elderly because of higher bone fragility due to osteoporosis. Numerous chronic illnesses, which usually affect the elderly, aggravate and complicate their surgical treatment. Trochanteric femoral fractures results in high morbidity and mortality in elderly patients. The aim of our study is to evaluate the effectiveness of hemiarthroplasty in the treatment of unstable trochanteric femoral fractures in elderly patients. Between 2000 and 2005, 50 patients with unstable trochanteric femoral fractures (41 women) aged 75 to 92 years (mean 86 years) underwent cemented hemiarthroplasty. The surgical procedure was performed within first 48 hours after the fracture (out of which 14 in the first 12 hours, 27 in the first 24 hours and 9 in the first 48 hours), with minimal blood loss. Hemiarthroplasty was indicated in patients where stability was important to allow early mobilization. In forty patients (80%) early ambulation with full weight bearing was achieved during the short period of hospitalization (9-14 days). Given that the affected population is predominantly the elderly, who are less mobile and demanding and thus put less strain on the endoprosthesis, we believe that this kind of treatment is the treatment of choice for unstable trochanteric femoral fractures in these patients. This assumption is corroborated by the fact that we did not have any endoprosthesis luxation, apparent acetabular protrusion or instability during the mean follow up period of 15 months (range 12-18 months).

Torsion of epiploic appendage mimic acute appendicitis.

Epiploic appendagitis is a rare cause of focal abdominal pain which, depending on its localisation, can mimic a variety of abdominal diseases. We report a case of 36-year-old woman who presented with a classic signs of acute appendicitis. On examination, the obese, afebrile, and had very strong right iliac fossa tenderness and guarding. The white cell count was 12.82 x 10(9)/L, and C reactive protein count was 15.13MG/DL. She underwent emergency laparoscopic procedure after the acute appendicitis diagnosis has been established. Laparoscopic exploration of the abdominal cavity showed vermiform, no inflamed, appendix and necrotic appendix epiploica of the caecum. The treatment consisted of typical laparoscopic appendectomy and laparoscopic resection of the necrotic appendix epiploica. The patient made rapid recovery and was discharged from the hospital on second day after the operation. Histological investigation of the appendix epiploica revealed gangrenous epiploic appendage.

[Lumbosacral spine herniation--computed tomography diagnostics]. / Hernije lumbosakralne kraljeznice--analiza temeljem CT dijagnostike.

The aim of this retrospective study was to establish the incidence of particular types of disk radicular conflicts of the lumbar region. The study showed no patient sex or age differences. Disk radicular conflicts were most commonly diagnosed at L5-S1 and L4-L5 levels. Study results pointed to dorsomedial protrusion of the intervertebral disk to be most common in the study region, followed by dorsolateral one, whereas foraminal protrusion of the intervertebral disk was the rarest one. Study results suggested that there was no significant age or sex difference in the incidence of disk radicular conflicts of the lumbar region.

Advantages of the spared surgical treatment of the spleen injuries in the clinical conditions.

BACKGROUND/AIMS: Aim of this study was to compare clinical, biochemical and hematological parameters of the patients after posttraumatic splenectomy, posttraumatic spleen preservation and auto transplantation and the control group of the patients. METHODOLOGY: The study included data on 169 patients treated at the University Surgery Department, University Hospital Split, from 1998 till 2006. There were 127 male, and 42 female patients, mean age was 40,3 years (range 15-74), 137 of the patients underwent surgery and 32 were treated without operation. A group of 29 patients, who underwent inguinal hernia repair, was the control group. RESULTS: Reduction in postoperative morbidity, hospital stays and blood products administration are achieved if the spleen is preserved. The values of Howell-Jolly bodies, CH50 complement particles, IgM antibodies, lymphocytes and monocites are reduced if the spleen is not preserved. CONCLUSION: No operative treatment and spleen preserving surgical procedures are superior to the splenectomy in the spleen trauma treatment. Splenectomy should be avoided whenever is possible.

Laparoscopic abdominal cysts fenestration using harmonic scalpel.

The use of ultrasonically activated scalpel for tissue cutting and coagulation is a potential replacement for electrosurgery, which can be related to different complications. Its working principle is to transform the electric power into the mechanical longitudinal movement of the working part of the instrument, by a piezoelectric transducer situated in the hand piece. Between October 2000 and June 2004, six patients with abdominal cysts were treated by laparoscopy, using the harmonic scalpel. The average age was 40.8 (ranging from 15-60) years. Laparoscopic abdominal cyst fenestration was performed in five patients, and laparoscopic cholecystectomy and abdominal cyst fenestration were done in one patient during the same operation. The average duration of the operation was 40 (ranging from 25-70) minutes and hospital stay was 2.8 (ranging from 1-5) days. Laparoscopic abdominal cyst fenestration using the harmonic scalpel is a safe and successful operation, with good results including all the advantages of the minimally invasive surgery.

Mine clearance injuries in South Croatia.

OBJECTIVE: The purpose of this retrospective study was to describe and analyze casualties in mine-clearance operations in South Croatia from 1991 to 1995. During the war in Croatia, the laying of mines by both sides was largely unplanned, without mapping or documentation, making demining, an already expensive, complicated task, even more dangerous. METHODS: The study comprised all those injured in mine-clearance operations treated at Clinical Hospital Split. The type of mines used, the mechanism of the incident, and the location and severity of injury according to the Abbreviated Injury Scale and the Injury Severity Score were analyzed. RESULTS: In a 5-year period, 160 pyrotechnicians of the Croatian Army performed demining in Southern Croatia. In 29 incidents, 53 deminers were injured. The degree of injury according to the Abbreviated Injury Scale was 2.85 +/- 0.6 and Injury Severity Score grade was 19.68 +/- 8.57. Two of the injured died. CONCLUSION: To find and remove approximately 2 million mines laid in Croatia will take at least 10 years and 2,000 to 3,000 specialized personnel. Unfortunately, the results of the study demonstrate that a significant number of deminers will suffer grave injuries or die in the process.