Severe form of streptococcal necrotizing fasciitis of the upper limb--diagnostic and therapeutic challenge: A case report.

INTRODUCTION: Since delay in recognition and effective treatment of necrotizing fasciitis (NF) caused by invasive group A streptococcus increases the mortality and disability, the early diagnosis and management of this disease are essential for a better outcome. We presented a patient with a severe form of streptococcal NF of the left upper limb in whom amputation was performed as a life saving procedure. CASE REPORT: A 65-year-old man, previously healthy, suffered an injury to his left hand by sting on a fish bone. Two days after that the patient got fever, redness, swelling and pain in his left hand. Clinical examination of the patient after admission indicated NF that spread quickly to the entire left upper limb, left armpit, and the left side of the chest and abdomen. Despite the use of aggressive antibiotic and surgical therapy severe destruction of the skin and subcutaneous tissues developed with the development of gangrene of the left upper limb. In this situation, the team of specialists decided that the patient must be operated on submitted to amputation of the left arm, at the shoulder. After amputation and aggressive debridement of soft tissue on the left side of the trunk, the patient completely recovered. beta-hemolytic streptococcus group A was isolated from the skin and tissue obtained during the surgery. CONCLUSION: In the most severe forms of streptococcal NF of the extremities, adequate multidisciplinary treatment, including limb amputation, can save the life of a patient.

Evaluation of comparative results of rehabilitation of patients with acromioclavicular dislocation of the third degree treated by surgical techniques by Phemister and Vukov.

INTRODUCTION: In terms of access to treatment of acromioclavicular joint injuries, there are many controversies, especially after the appearance of works that promote "neglecting of injury". GOAL: The aim of this paper is to give a comparative analysis of the results of rehabilitation of patients after acute injury of the acromioclavicular joint of the third degree, treated by two surgical techniques: by Phemister and Vukov. MATERIAL AND METHODS: In this study, we investigated a total of 60 operated patients: 30 patients were operated by Phemister techniq-ue, and 30 by Vukov technique. RESULTS: Postoperative follow-up lasted for one year. Between these two groups, the time when the rehabilitation process began is significantly different p < 0.01. With technique by Vukov, the rehabilitation begins on the first postoperative day and with technique by Phemister it begins later (after 7 weeks outpatient). With technique by Phemister, rehabilitation lasted on average 60 days, and with technique by Vukov on average 40 days. The duration of recovery is also significantly different p < 0.01, with technique by Vukov the duration time is shorter, and therefore the process of rehabilitation in days--is shorter than with the other technique. Both techniques gave good stability of the lateral end of clavicle. The difference was not statistically significant p > 0.05, which means that both techniques can be applied depending on the indication and the experience of the surgeon.

Rehabilitation of a patient after operationally treated idiopathic recurrent, posterior shoulder subluxation.

INTRODUCTION: involuntary, idiopathic, recurrent posterior shoulder subluxation is a rare entity. Subluxation of the shoulder joint occurs with every elevation movement of the hand with a certain level of pain. Active abduction and anteflexion are possible only to 90 degrees. Only surgical treatment produces results. GOAL: The goal is to show that timely commenced, continuously conducted rehabilitation of the shoulder after surgically repaired involuntary, idiopathic, recurrent posterior subluxation of the shoulder, leads to restitution of function. Case outline R.M. patient 24 years old, was admitted to the Institute for Orthopaedic Surgery and Traumatology, Clinical Center in Belgrade, for surgical treatment. Previously was treated conservatively. ROM (anteflexion 700 abduction 60 degrees) with persistant pain in shoulder. Rehabilitation started first postoperative day. RESULT: - 2.5 months post surgery- ROM (active movement) antetlexion 165 degrees, abduction 140 degrees, without pain and no tendency of posterior subluxation. - 3.5 months post surgery,full active movements were achieved, except external rotation of -20 degrees. - 5 months post surgery, the patient had full range of motion in all directions.The last control was performed one year after surgery. The patient has no symptoms, lives normal life and is engaged with sports.

Shoulder hemiarthroplasty rehabilitation with fractures.

UNLABELLED: Fractures of the upper end of the humerus are relatively common. They are predominant in the female population (85%), age over 50 years, where the force that leads to fractures in 90% of cases is moderate. Multifragmentary (three-part and four-part) fracture of the upper end of humerus, treated nonoperatively, often leaves behind a significant disability. MATERIALS AND METHODS: Between October 2003-2010, the rehabilitation of 34 patients with shoulder hemiarthroplasty was carried out. RESULTS: The achieved results are accompanied by a precise evaluation of Constant-score, after sixth month of operation. By scoring system, it estimates the pain, the mobility of the shoulder joint, the functional evaluation of the hand and grip strength. In 25 patients (73.5%) the Constant-score was >90 points. In 7 patients (20.6%) was 80-89, and in 2 patients (5.9%) the value of Constsant-score was < 60 points. CONCLUSION: The maximum possible restitution of shoulder function in patients with shoulder hemiarthroplasty is-provided by: well conducted operation--early started, adequate kinesiotherapeutic protocol, implemented long enough--a good motivation of patients for the treatment.