The predictive value of the clinical sign of limited hip abduction for developmental dysplasia of the hip (DDH).

Aim To assess the relationship between the clinical sign of limited hip abduction and developmental dysplasia of the hip (DDH). Methods A research was conducted on 450 newborns at the Neonatal Unit at the Clinic of Gynaecology and Obstetrics and the Orthopaedics and Traumatology Clinic of the University Clinical Centre, Tuzla, between 30th August 2011 and 30th April 2012. Clinical (degree of hip abduction) and ultrasound examination of all newborns' hips were performed using the Graf method on their first day of life. Results Clinical sign of limited hip abduction showed significant predictive value for DDH. There were 67 (14.7%) newborns with the clinical sign of limited hip abduction, of which 26 (5.7%) were on the left hip, 11 (2.4%) on the right hip and 30 (6.6%) on both hips. Limited hip abduction had a positive predictive value (PPV) of 40.3% and a negative predictive value (NPV) of 80.4% for DDH. Conclusion Limited hip abduction, especially unilateral, is a useful and important clinical sign of DDH. Doctors, who perform the first examination of the child after birth, would have to pay attention to this clinical sign. Newborns with this clinical sign would have to go to an ultrasound examination of the hips for further diagnosis.

Proximal femoral nail antirotation in treatment of fractures of proximal femur.

INTRODUCTION: Fractures of the proximal femur and hip are relatively common injuries in adults and common source of morbidity and mortality among the elderly. Many methods have been recommended for the treatment of intertrochanteric fractures. MATERIAL AND METHODS: We retrospective analyzed all the patients with fractures of the hip treated with proximal femoral nail antirotation (PFNA) at the Clinic of Orthopedic and Traumatology, University Clinical Centre Tuzla from the first of January 2012 to 31 December 2012 years. The study included 63 patients averaged 73.6 +/- 11.9 years (range, 29 to 88 years). Fracture type was classified as intertrochanteric (Arbeitsgemeinschaft für Osteosynthesefragen classification 31.A.1, A.2 and A.3) and subtrochanteric fractures (Seinsheimer classification). RESULTS AND DISCUSSION: The ratio between the genders female-male was 1.6:1. There was statistically significant difference prevalence of female compared to male patients (p = 0.012). There were 31 left and 32 right hip fractured. Low energy trauma was the cause of fractures in 57(90.5%) patients. Averaged waiting time for hospitalization was 3.2 +/- 7.5 days (range, 0 to 32 days). 44 patients were admitted the same day upon injuring. The average waiting time for the treatment was 3.6 +/- 5.7 days. The ratio between with or without co-existent disease was 4.7:1. During the three months postoperatively with ASA score 3 and 4 six patients died. There were no significant differences in deaths from ASA score 1 and 2 (p = 0.52). Reoperation for the treatment of implant or fracture-related complications was required in three (4.7%) patients (infection, reimplantation and extraction). Three patient developed deep vein thrombosis. Statistically significant difference was found in the deaths in the first three months compared to the next three months (p = 0.02). We found statistically significant difference between pre-injury and postoperative mobility score (p = 0.0001). CONCLUSION: PFNA is an excellent device for osteosynthesis as it can be easily inserted. Moreover, it provides stable fixation, which allows early full weightbearing mobilization of the patient.

Vascular geometry of vertebrobasilar tree with and without aneurysm.

AIM: To examine a possible relationship between the variable vascular geometry of vertebrobasilar joint angle and basilar bifurcation angle as well as the diameters of these blood vessels. METHODS: The study included 60 adult patients, of both sexes, who were divided into two groups. One group (30) consisted of patients without aneurysm of vertebrobasilar tree, and another group (30) of patients with aneurysm. The patients were examined using Magnetic Resonance Imaging (MRI) and Computed Tomography Angiography (CTA) of head and neck. RESULTS: In the group without aneurysm of vertebrobasilar tree, in 14 (46.6%) patients diameters of the right and the left vertebral artery were approximately the same. The average value of the angle of junctions of vertebral arteries was 65.43°, and the average angle of basilar bifurcation was around 94.53°. In the group with aneurysm of vertebrobasilar tree, in 12 (40%) patients diameters of the right and the left vertebral artery were also approximately the same. The average angle of junction of vertebral arteries was 68.46º, and the average angle of basilar bifurcation was 121.93º. CONCLUSION: Anatomic variations of the vertebrobasilar joint angle and basilar bifurcation angle, as well as the diameters of these blood vessels, are some of the factors in the increase of the incidence of aneurysm in this anatomic area.

Complications and functional recovery in treatment of femoral shaft fractures with unreamed intramedullary nailing.

INTRODUCTION: Fracture of the femoral shaft is a common fracture encountered in orthopedic practice. In the 1939, Küntscher introduced the concept of intramedullary nailing for stabilization of long bone fractures. Intramedullary nailing has revolutionized the treatment of fractures. MATERIAL AND METHODS: The study included 37 male patients and 13 female patients, averaged 39 +/- 20.5 years (range, 16 to 76 years). RESULTS AND DISCUSSION: There were 31 left femurs and 21 right femurs fractured. 46 fractures were the result of blunt trauma. Low energy trauma was the cause of fractures in six patients, of which five in elderly females. 49 fractures were closed. Healing time given in weeks was 19.36 +/- 6.1. The overall healing rate was 93.6%. There were three (6.25%) major complications nonunion. There were one (2%) delayed union, one (2%) rotational malunion and no infection. The shortening of 1 cm were in two patients. Antercurvatum of 10 degrees was found in one patient. There was no statistically significant reduction of a motion in the hip and knee (p < 0.05). There was statistically significant in the thigh (knee extensors) muscle weakness (p < 0.001). CONCLUSION: : Intramedullary nailing is the treatment of choice for femoral shaft fractures.

Proximal femoral nail antirotation in treatment of fractures of proximal femur.

INTRODUCTION: Fractures of the proximal femur and hip are relatively common injuries in adults and common source of morbidity and mortality among the elderly. Many methods have been recommended for the treatment of intertrochanteric fractures. MATERIAL AND METHODS: We retrospective analyzed all the patients with fractures of the hip treated with proximal femoral nail antirotation (PFNA) at the Clinic of Orthopedic and Traumatology, University Clinical Centre Tuzla from the first of January 2012 to 31 December 2012 years. The study included 63 patients averaged 73.6±11.9 years (range, 29 to 88 years). Fracture type was classified as intertrochanteric (Arbeitsgemeinschaft für Osteosynthesefragen classification 31.A.1, A.2 and A.3) and subtrochanteric fractures (Seinsheimer classification). RESULTS AND DISCUSSION: The ratio between the genders female-male was 1.6:1. There was statistically significant difference prevalence of female compared to male patients (p=0.012). There were 31 left and 32 right hip fractured. Low energy trauma was the cause of fractures in 57(90.5%) patients. Averaged waiting time for hospitalization was 3.2±7.5 days (range, 0 to 32 days). 44 patients were admitted the same day upon injuring. The average waiting time for the treatment was 3.6±5.7 days. The ratio between with or without co-existent disease was 4.7:1. During the three months postoperatively with ASA score 3 and 4 six patients died. There were no significant differences in deaths from ASA score 1 and 2 (p=0.52). Reoperation for the treatment of implant or fracture-related complications was required in three (4.7%) patients (infection, reimplantation and extraction). Three patient developed deep vein thrombosis. Statistically significant difference was found in the deaths in the first three months compared to the next three months (p=0.02). We found statistically significant difference between pre-injury and postoperative mobility score (p=0.0001). CONCLUSION: PFNA is an excellent device for osteosynthesis as it can be easily inserted. Moreover, it provides stable fixation, which allows early full weightbearing mobilization of the patient.