[Bilateral Dislocation of the Hip Joints after a Car Accident?] / Bilaterálna traumatická luxácia bedrových klbov po autonehode?

The authors describe a case report of a 5-year-old foreign girl with a rare bilateral hip dislocation after a car accident. Young surgeons at the emergency department performed an unsuccessful closed reduction. Since the clinical and ultrasound screening of DDH of all newborns in the Slovak Republic is carried out until the age of 4-6 weeks, the treatment of dislocated hips starts early and the late diagnosed dislocations occur rarely. The aim of the study is to point at differences in DDH screening all over Europe resulting in an increased risk of misdiagnosed patients. Key words:hip dislocation, childhood, trauma, DDH, screening.

Bone metastases in neuroendocrine tumors.

Neuroendocrine tumors arise from various cells that form a part of the endocrine system and account for a small number of cases encountered by oncologists in clinical practice. The clinical incidence of these tumors used to be low, and newer imaging modalities have now begun to be used for detecting bone metastases at an earlier stage. Bone metastases arising from neuroendocrine tumors are a well-recognized complication. Their presence carries along a poor prognosis. Clinical symptoms are similar to those encountered in other forms of cancer that are complicated by bone metastasis. Over the last decade or so, the clinical detection, diagnostic methods and treatment strategies have changed dramatically, and new treatments are emerging slowly. The indolent course of neuroendocrine tumors and the development of bone metastasis have limited our current knowledge on how to best prevent and manage the condition. Current information available from clinical studies is marred by paucity and small sample sizes, making further clinical trials an absolute necessity. In this review, we discuss the current status in the diagnosis and management of bone metastases arising from neuroendocrine tumors (Fig. 3, Ref. 28).

Acute pain: a multifaceted challenge - the role of nimesulide.

BACKGROUND: This article summarizes the outcome from an international consensus meeting, which took place in Vienna on 4 November 2014. SCOPE: The aim of the meeting was to provide the state of the art on the pathophysiology and treatment of acute pain with special emphasis on nimesulide, a non-steroidal anti-inflammatory drug (NSAID) indicated for the treatment of acute pain and primary dysmenorrhea. Besides the data on the mechanisms of acute inflammatory pain and on the efficacy and safety of nimesulide in patients affected by different forms of acute pain, the clinical experience of attending experts was discussed based on selected case reports. RESULTS: The members of this consensus group recognized that nimesulide is a NSAID highly effective in the treatment of several painful situations with an acute inflammatory component including primary dysmenorrhea. Although safety concerns regarding nimesulide have emerged in recent years, both robust new epidemiological data and clinical experience confirm a positive benefit/risk profile of nimesulide in the treatment of several forms of acute pain. CONCLUSIONS: The members of this international consensus group concluded that nimesulide, when used appropriately, remains a particularly valuable and safe option for the treatment of several conditions characterized by the presence of acute inflammatory pain because of the rapid onset of the analgesic action, and the positive evidence-based benefit/risk profile.

[Osteochondroma of the iliac crest: case report]. / Osteochondróm lopaty iliakálnej kosti.

The authors present the case of a 16-year-old boy with osteochondroma of the iliac crest which gradually resulted in gluteal muscle atrophy, developing curvature of the spine and compression of the external iliac artery. Osteochondroma excision prevented the development of circulatory disorders in the ipsilateral lower extremity, and effective physical therapy enabled the well cooperating patient to restore fully his gluteal muscle strength and normal gait pattern.

[Diagnostic options in chronic recurrent multifocal osteomyelitis: case reports]. / Moznosti diagnostiky chronickej multifokálnej recidivujúcej osteomyelitídy: kazuistiky.

Chronic recurrent multifocal osteomyelitis (CRMO) is the most severe form of chronic non-bacterial osteomyelitis. In children and adolescents, the metaphyses of long bones are affected most frequently, but the lesions can be found at any site on the skeleton, as well as in other organs such as the skin, eyes, gastrointestinal tract or lungs. Since the clinical signs of CRMO and its course are not invariable and clear, it is often very difficult to make a clinical diagnosis. The authors present their experience with the CRMO diagnosis in three cases. In the first patient, CRMO was localised in the left proximal tibia, left proximal femur, left sacrum and left clavicle bone. In the second patient, it was found in the left distal tibia, tarsometatarsal joints of the left foot and left distal femur. The third patient showed lesions in the inferior pubic ramus and ischial bone on the left side.With interdisciplinary co-operation it was possible to make the exact diagnosis of CRMO in all three female patients, and the disease was successfully managed. A precise therapeutic procedure could be derived from the results of randomised controlled studies which, however, cannot be made because of an infrequent occurrence of this disease. A meta-analysis of the cases so far published in the literature would be a more likely option.

Vascularized free fibular graft in the treatment of congenital pseudarthrosis of tibia.

UNLABELLED: Aim of the study was to evaluate the results of the patients with "congenital pseudartrosis of tibia" treated by vascularized fibular graft transferred from the contralateral calf. MATERIAL AND METHODS: The cohort consist of four patients (2 boys and 2 girls) aged 5.75 y (range 4-8 years) in the time of the transfer of vascularized fibular graft from the contralateral calf into the resected tibia suffered from pseudarthrosis Crawford type II, III and IV. Patients were operated on between 1999-2007. RESULTS: A total graft union was achieved in three patients in one-year follow-up period. In one girl, treatment failed due to infection and was treated later with intramedullar Rush nail fixation and additional spongioplasty with an unsatisfactory result. CONCLUSION: Authors believe that after an accurate preoperative planning in cooperation with the microsurgeon, the treatment of congenital pseudarthrosis of the tibia by vascullarized fibular graft should be considered as a very effective, accurate and relatively safe method (Tab. 2, Fig. 4, Ref. 7). Full Text (Free, PDF) www.bmj.sk.

Functional results in patients with sarcoma around the knee joint.

Authors evaluated functional outcomes after three different surgical procedures for sarcoma around the knee joint. Sixteen patients with sarcoma were given four to six preoperative courses of chemotherapy. Patients were separated into three groups according to the pattern of tumour excision. The first group underwent the resection of proximal fibula and tibialis anterior muscle resection, the second group underwent resection of distal femur or proximal tibia with total knee replacement, and the third group underwent radical amputation. The mean functional evaluations were 100, 95 and 80%. All marginal resections of proximal fibula resulted in excellent function. No local evidence of tumour recurrence was seen at mean follow-up of 24 months (Tab. 1, Fig. 2, Ref. 7).

[First experience with correction of limb-length inequality and angular and rotational deformities of the tibia using the Taylor spatial frame]. / Korekcia uhlových, dlzkových a rotacných deformít predkolenia Taylorovým priestorovým rámom--prvé skúsenosti.

The authors analyse the first results of correction surgery for limb-length inequality and rotational and angular deformities of the tibia using the Taylor spatial frame in combination with the Ilizarov external fixator in three patients. The shortening of the tibia, 65 mm on the average (55, 60 and 80 mm, respectively), was due to tibial hemimilia in two patients and traumatic epiphyseolysis of the distal tibia in one patient. Distraction at a rate of 1 mm/day was controlled three-times a day on two contralateral struts. It started on the seventh day after osteotomy in all three patients. On the second post-operative day, rehabilitation started with standing up and walking with crutches. The additional fixation of the heel and foot was removed at 3 months after distraction was terminated so that ankle exercise would be possible. No serious complications were recorded. The average distraction index was 0.91 and the average tibial lengthening was 65 mm. Callus consolidation was achieved at 131 days after the end of distraction phase. Approximately at 10 months post-operatively, the patients reported full weight-bearing of the extremity.

[Role of an interdisciplinary approach in the healing of long bone fractures in patients with osteogenesis imperfecta]. / Moznost interdisciplinárneho ovplyvnenia hojenia zlomenín dlhých kostí u osteogenesis imperfecta.

PURPOSE OF THE STUDY: The aim of the study was to analyze a group of patients who had undergone multilevel osteotomy of long bones and medication therapy for osteogenesis imperfecta (OI). MATERIAL AND METHODS: The group included 14 OI patients (nine girls and five boys) operated on in the years 1996 to 2006, who ranged in age from 3 to 17 years (average, 8.2 years). Due to residual deformation following a fracture of or because of treatment for acute trauma to long bones of the lower extremities, the patients underwent multilevel osteotomy with the use of osteosynthesis (Prevot's rod, six patients; Kirschner's wire, three patients; Küntcher's nail, three patients; Rush's nail, one patient; condylar plate, one patient). A special working and rehabilitation program played an important role in the therapeutic protocol. Four patients treated after 2003 received Pamidronate. RESULTS: Sufficient correction of axil deformity of the legs and equal leg length resulting in gait improvement were achieved in 11 patients. In one patient, osteosynthesis with a condylar plate failed and it was necessary to apply intramedullary elastic fixation. In one patient, tibia vara developed following Küntcher's nail osteosynthesis. In one patient, disunion of bone from osteosynthetic material, with a subsequent supracondylar fracture under the Küntcher's nail, was recorded. Pamidronate administered in pre- and post-operative periods to the four patients treated after 2003 reduced the need for their immobilization from 6 to 3 weeks, which permitted early rehabilitation and, in one patient, first standing and walking at the age of 12 years. DISCUSSION: The treatment of long bone fractures in OI patients is based on the assumptions that bone healing is not affected and that long immobilization leads to deterioration of osteopenia and to a risk of further fractures. For these reasons, surgical procedures using intramedullary fixation have recently been preferred. Pamidronate administration alleviates pain, improves muscle tonus, reduces the period of immobilization and enhances bone density. CONCLUSIONS: The multidisciplinary, rational approach, which involves early surgical intramedullary fixation of fractures with subsequent rehabilitation and Pamidronate administration, is considered to provide a more effective therapy with better results and therefore better quality of life in patients with osteogenesis imperfecta.

[Efficacy of antiseptics in the prevention of post-operative infections of the proximal femur, hip and pelvis regions in orthopedic pediatric patients. Analysis of the first results]. / Prvé výsledky analýzy úcinnosti antiseptík v prevencii pooperacných infekcií v oblasti proximálneho femuru, bedrového klbu a panvy u detských ortopedických pacientov.

PURPOSE OF THE STUDY: In orthopedics an infected operative wound always presents a serious complication that, apart from many adverse effects on the patient, increases the costs of therapy. The aim of this study was to analyze the effectiveness of antiseptic agents in the prevention of postoperative complications associated with surgery on the proximal femur, hip and pelvis in children. MATERIAL: This prospective randomized study included 162 patients with the following diagnoses: cerebral palsy, developmental hip dysplasia, Perthes' disease, epiphyseolysis of the femoral head, and tumors. A total of 182 surgical procedures were carried out on soft and bone tissues in the proximal femur, hip and pelvis regions. The patients were allocated to two groups according to the intra-operative conditions used. Group 1, including 89 patients, was treated with 3.5 % solution of betadine before final closing of the wound and group 2, comprising 73 patients, received no betadine irrigation during the intraoperative period. The other operative and post-operative conditions provided for the patients were identical; surgery was carried out in one operating theatre without laminar air flow. RESULTS: The average follow-up was 7.8 months (range, 2-14 months). No infected operative wound was observed in group 1, and two superficial wound infections were recorded in group 2. CONCLUSIONS: The first results of our study suggest the need of prophylactic intra-operative irrigation of wounds in the hip and pelvis region. Irrigation with a diluted betadine solution is indicated in accord with the risk factors of the patient's diagnosis and the site of surgery, and also when the operative time is longer, there is insufficient protection with single-use surgical toweling, laminar air flow is present in the operating theatre or for other reasons.

Developmental dysplasia of the hip. Prevention and real incidence.

OBJECTIVE: The controversy over the incidence of developmental dysplasia of the hip (DDH) stems mainly from an ambiguity of criteria for defining a genuinely pathologic neonatal hip. The aim of this study was to identify those neonatal hips which, if left untreated, would develop any kind of dysplasia and, therefore, are to be included in the determination of DDH incidence. METHODS: Clinical and ultrasonographic examinations for DDH were performed on 4356 neonatal hips. Newborns with skeletal deformities, neurologic/muscular disorders, and neural tube defects were excluded. Hips that featured any type of sonographic pathology were reexamined at 2 or 6 weeks, depending on the severity of the findings. Only hips in which the initial pathology was not improved or had deteriorated were treated; all others were examined periodically until the age of 12 months. RESULTS: Sonographic screening of 4356 hips detected 301 instances of deviation from normal, indicating a sonographic DDH incidence of 69.5 per 1000. However, only 21 hips remained abnormal and required treatment, indicating a true DDH incidence of 4.8 per 1000 hips. All the others evolved into normal hips, and no additional instances of DDH were found on follow-up throughout the 12 months. CONCLUSIONS: These findings enables us to distinguish two categories of neonatal hip pathology: one that eventually develops into a normal hip (essentially sonographic DDH); and another that will deteriorate into a hip with some kind of dysplasia, including full dislocation (true DDH). This approach seems to allow for a better-founded definition of DDH, for an appropriate determination of its incidence, for decision-making regarding treatment, and for assessment of the cost-effectiveness of screening programs for the early detection of DDH (Tab. 2, Ref. 15).

Evaluation and treatment of hip joint instability in patients with cerebral palsy.

OBJECTIVES: Hip subluxation and dislocation in patients suffering from cerebral palsy (CP) develop in response to a muscle imbalance, caused by contracture of hip adductors and flexors. In the radiological measurement of hip joint instability, the Reimers migration percentage and migration index is used. These methods are useful in planning soft tissue or bony surgery and also for the post operative follow up. PATIENTS AND METHODS: Authors evaluated 15 spastic patients with spastic tetra and di-plegia with 19 dislocated hips who underwent one stage hip reconstruction between 1995-2000. At one stage surgery, adductor tenotomy, capsulotomy, iliopsoas tenotomy, shortening varus (rotation) femoral osteotomy and pelvic osteotomy was performed. RESULTS: Complete stability was obtained in 16 hips with neither redislocation nor subluxation. The mean MP was 11.5% at the 5 year follow up. In one patient, a bilateral proximal femoral resection due to painful hips was performed later. None of the patients showed evidence of AVN. CONCLUSION: Hip instability leading to subluxation or dislocation is a serious problem in children suffering from CP and is usually worse in severe condition. Once subluxation or dislocation occurs, muscle releases should be combined with varus and shortening osteotomy. In an acetabular insufficiency, pelvic osteotomy is necessary to obtain the stability (Tab. 1, Ref 2, Ref 8). Full Text (Free, PDF) www.bmj.sk.

"Different" approach in the operative treatment of congenital clubfoot and its results.

OBJECTIVES: This study compared long-term results of the treatment of idiopathic clubfoot at two different University orthopaedic departments. BACKGROUND: The treatment of clubfoot is still controversial due to different severity and different treatment philosophies. METHODS: Authors retrospectively analyzed a group of 273 feet (145 patients) operated on at the Unit of Pediatric orthopaedics, Children University Hospital, Bratislava (group A) and the cohort of 60 feet (33 patients) operated on at the Ist University Department of Orthopaedics, Bratislava (group B), between 1993 and 2002 with follow up period from 2 to 11 years (average 72 months). In the group A, McKay procedure was indicated in 3 feet, Carroll operation in 35 feet and 160 feet were operated by Brockmanns posteromedial release and its modifications (cuboid and metatarsal osteotomies). In the group B, McKay procedure was done in 8 feet and 50 feet were operated on by Turco/ Zacepin procedure. RESULTS: Recurrences in both groups due to the insufficient first step operative reduction and mistakes in after treatment were 12%. Satisfactory results (excellent and good) were achieved in 88% of cases in both groups. CONCLUSION: This study shows, that the results of operative treatment of congenital clubfoot from two different departments (using different operative techniques but "a la carte philosophy") were comparable in most of the cases (Tab. 4, Fig. 3, Ref: 9).

Long-term results of surgical treatment of patients suffering from cerebral palsy.

OBJECTIVES: Cerebral palsy is defined as a syndrome subsequent to attack of developing brain and characterized by loss of normal controle of motor function. Orthopaedic surgeon have to select patients who will have benefit from surgery, and to perform it by that way, that will improve the motorical ability of the child. BACKGROUND: The operations performed in the past at one level were replaced by modern ,,multilevel approach" in case of need. The aim of this study was the analysis of the long term results of that new surgical approaches. METHODS: Evaluated were 275 patients diagnosed as having spastic or mixed form of cerebral palsy (CP). The average age at the time of surgery was 7.8 years (3 to 16 years). Altogether in 20 years 941 surgical procedures, mainly on the lower limbs were performed. RESULTS: Overall 9 % excellent, 53 % very good, 26 % good and 12 % bad results were achieved. Using single level unilateral operations 7 % excellent, 46 % very good, 30 % good and 17 % fair results were achieved. Comparing to this, using the modern methods, 11 % excelent, 57 % very good, 23 % good and 9 % of bad results were achieved. CONCLUSION: Authors believe, that the broad and early multilevel surgery, acomplished with proper physiotherapy is an important fact for improvement of outcome in treatment of children suffering from cerebral palsy (Tab. 2, Ref 6).

[Paresis of the femoral nerve in pelvic extraperitoneal hematoma--case reports and literature review]. / Paréza femorálneho nervu pri extraperitoneálnom hematóme panvy--kazuistiky a prehl'ad literatury.

The authors describe two rare cases of femoral nerve paresis in pelvic extraperitoneal hematoma in children. The first case was a 13-year-old girl, with no trauma in her medical history, in whom the paresis was suspected to have inflammatory or tumorous etiology; the other case was a 14-year-old boy injured during playing football. In both patients, extraperitoneal pathology of the pelvis was evident clinically and was shown in CT scans; paresis of the femoral nerve was demonstrated by EMG. In both cases, surgical intervention revealed a hematoma causing neuropathy. This was removed and, within a year of first sign appearance, both patients were free from neurological symptoms. The authors consider early surgery to be a decisive factor in the course of this neurological complication, as the regeneration of nerve structures took nearly a year despite the adolescent age of the patients. No reports of similar conditions in children treated at the same institution were found in the relevant international literature.

Combination of osteotomy of the first metatarsal according to Frejka with McBride operation procedure in surgical therapy of extreme hallux valgus.

Hallux valgus is to be perceived as a complex of deformities of the first ray of the foot, often accompanied by deformity of forefoot. Although, this deformity can be treated with as many as 200 surgical procedures, the authors would like to demonstrate the effect of their own approach. The authors evaluate the results of hallux valgus surgery combining the operation according to McBride and wedge osteotomy of the first metatarsal (MT) basis in 21 patients (37 surgeries) with post-surgical follow-up lasting from 29 to 45 months (i.e. 3 years in average). Pre-operative mean intermetatarsal 1-2 angle revealed by radiographs was surgically corrected from 21.7 degrees at the baseline to the mean degree of 8.8. The pre-surgical average 45.9-degree of great toe valgosity proved by radiographs was surgically improved to the mean of 13.5 degrees. 87% of patients expressed their personal satisfaction with their surgical results. The authors consider the combination of wedge osteotomy of the first metatarsal basis with the operation according to McBride to be suitable in the therapy of extreme valgosity of great toes with increased metatarsal angle between first and 2nd metatarsal in young patients with minimum of changes in the metatarsophalangeal joint developed due to arthrosis (Tab. 2, Fig. 6, Ref. 7).

[Role of forensic medicine and forensic psychiatry in solving the problem of organized crime]. / Ucast' súdneho lekárstva a forenznej psychológie na riesení problematiky organizovaného zlocinu.

Term--organized crime is not satisfactorily defined todate neither in forensic sciences, nor in lexical formulations. It is necessary to come to grips with the criminalistic and social pathological meaning of three terms--individual crime, grouped and organized crime as well as participation of forensic sciences including forensic medicine on solving problems of organized crime. Forensic medicine and forensic psychology can help to solve this acute problem of present development of social life. It can help in criminalistic expertize and insider activity in profiliation of perpetrators and victims. Mainly it will be about searching and improving of methodical approaches in solving of incriminated cases and its analysis for investigative organs and courts. Important asset in this problem must be also preventive portion in preclusion of criminality.

[Views of forensic medicine and criminology on the pathodynamics of homicide]. / Súdnolekársky a kriminologický pohl'ad na patodynamiku vrazdy.

Trauma and violence represent the domains of forensic medical expertise. The objective finding on the victim of the homicide makes it possible to reconstruct the way and mechanism of the injury connected with it and thus to determine the cause of death. The traces of violence contain many indices pointing at specific personal characteristics of the culprit, his motivation to the crime and his state of mind at the time of the homicide. To judge the penal responsibility and the guilt of the culprit it is important for the court to have the analysis of the dynamics and of the causal background of the crime, especially the synthetic evaluation of subjective, situation, or eventually psychological factors of violence with the mortal effect. The interdisciplinary forensic-medical, forensic-psychological and psychophytological approach will make it possible to provide the court with a complex forensic expertise.

[Arthroplasty according to colonna - 1999.]. / Colonnova artroplastika - 1999.

Authors evaluate results of arthroplasty according to Colonna.The surgery was performed at the Ist University department of orthopaedics in Bratislava in the period of 1955-1973. Of 97 patients (123 hips), 64 (79 hips) were followed up 5-25 years and 23 (31 hips) over 25 years. All patients at the last follow up for were assessed as having not satisfactory results, because of early pain at the operated side, limited movement of the hip joint and radiologically evident arthritic changes. Key words: Colonna, arthroplasty, DDH.