Dragana Matanovic

Triple pelvic osteotomy in the treatment of Legg-Calve-Perthes disease

This article presents the results of Legg-Calve-Perthes (LCP) disease treatment using triple pelvic osteotomy. Thirty patients were analysed. The conditions for inclusion in the study were complete medical documentation and follow-up until the disease was resolved. Postoperatively, no patients were immobilised. Rehabilitation was initiated early in all patients, and full weight bearing was allowed after tenxa0weeks. With this method, an increase of the CE angle of 17.43u2009±u20094.020° was achieved. Containment was increased from an initial 6.67% to 53.33% of patients at the final check-up. Similar improvement was achieved by using Herring classification of the damage; preoperatively most hips belonged to group C, and postoperatively to group A. Postoperatively, functional results were also considerably improved. The authors recommend triple pelvic osteotomy as the method of choice in the treatment of severe cases of LCP disease.ResuméLes auteurs présentent les résultats de la maladie de LCP traitée par triple ostéotomie pelvienne. 30 patients ont été analysés. Les conditions d’inclusion ont été les possibilités d’analyser de façon complète tous les documents avec une pathologie soit en fin d’évolution. En post-opératoire aucun des patients n’a été immobilisé et tous ont bénéficié d’une rééducation précoce avec un appui complet à 10 semaines. Cette méthode montre une amélioration de l’angle CE de 17.43±4.020°. La congruence s’est améliorée de 6,67% à 53,33% à la dernière revue. Une amélioration indentique a été retrouvée avec la classification de Herring avec une majorité de hanche en C préopératoire et en A post-opératoire. De même, en ce qui concerne les résultats fonctionnels. Les auteurs pensent que la triple ostéotomie pelvienne est une méthode de choix dans le traitement des lésions sévères de la maladie de LCP.

Is pre-fracture functional status better than cognitive level in predicting short-term outcome of elderly hip fracture patients?

Introduction The aim of the study was to determine to what extent severe cognitive impairment impacts short-term rehabilitation outcomes of elderly patients with proximal hip fracture. Material and methods A total of 337 community-dwelling elderly patients with acute hip fracture were observed during a 12-month period at a major teaching hospital in Serbia. Cognitive status was assessed at admission with the Short Portable Mental Status Questionnaire (SPMSQ). Outcome after 4 months was analysed with respect to presence of severe cognitive impairment, defined as an SPMSQ score of < 3. Outcome assessment included presence of postoperative complications, absolute motor Functional Independence Measure (FIM) gain, Activities of Daily Living index (ADL), Instrumental Activities of Daily Living score (IADL), and walking ability. Results An SPMSQ score of < 3 was observed in 36 patients (10.7%) with acute hip fracture. Patients with an SPMSQ score of < 3 achieved worse short-term outcomes regarding all observed variables. However, cognitive status was found to be an independent predictor only with respect to mortality at 4 months (odds ratio (OR) = 0.969, 95% confidence interval (CI) = 0.947-0.992, p = 0.009). In contrast, pre-fracture motor FIM independently predicted mortality (OR = 2.982, 95% CI = 1.271-7.000, p = 0.012), and preserved walking ability at 4 months follow-up (OR = 0.945, 95% CI = 0.912-0.980, p = 0.002). Correspondingly, pre-fracture ADL was an independent predictor of absolute motor FIM gain at 4 months follow-up (OR = 0.175, 95% CI = 0.405-11.426, p = 0.035). Conclusions Failure to consider functional status prior to fracture might overestimate the impact of cognitive status on functional outcome of hip fracture patients.

Triple pelvic osteotomy for the treatment of residual hip dysplasia. Analysis of complications

The aim of the paper was to present the results achieved with triple pelvic osteotomy in the treatment of residual hip dysplasia, with special interest in identifying recurrences and complications and how to avoid them. 60 patients (76 hips) with developmental dysplasia of the hip (DDH), treated by the triple pelvic osteotomy according to Tönnis and modified by Vladimirov, were included in the study. Hips were evaluated radiologically with the center-edge (CE) angle, break of the Shenton-Menard arch and index of acetabular depth by Heyman-Herndon, and functionally using the Harris Hip Score (HHS). The postoperative results showed an average increase of the CE angle by a mean of 23.5+/-9.28 degrees, with a highly significant difference between the preoperative and final postoperative findings (t-test, t=-20.85, p<0.01). The mean HHS significantly improved (p<0.01). Total complication rate was 13,1%, divided in: 1,3% (one case) of triple nonunion of iliac, pubic and ischial bones, 7,9% (six cases) of double nonunion of pubic and ischial bones, 2,6% (two cases) of peroneal palsy and 1,3% (one case) of infection. In this study the triple pelvic osteotomy showed to be reliable for acetabular dysplasia in adolescent and young adult, alone or in association with proximal femoral osteotomy and/or great trochanter distal advancement.

Predictive genetic markers of coagulation, inflammation and apoptosis in Perthes disease—Serbian experience

AbstractPerthes disease is one of the most common forms of pediatric femoral head osteonecrosis with an unknown etiology. Coagulation factors were the first genetic factors suspected to have a role in the pathogenesis of this disease, but studies showed inconsistent results. It is described that inflammation is present during early stages of Perthes disease, but its genetic aspect has not been studied extensively. Little is known regarding the status of apoptotic factors during the repair process that leads to the occurrence of hip deformity in patients. Therefore, the aim of this study was to analyze major mediators involved in coagulation, inflammation, and apoptotic processes as possible causative factors of Perthes disease. The study cohort consisted of 37 patients. Gene variants of TNF-α, FV, FII, and MTHFR genes were determined by PCR-RFLP, while IL-3 and PAI-1 were genotyped by direct sequencing. The expression level of Bax, Bcl-2, Bcl2L12, Fas and FasL was analyzed by quantitative reverse-transcriptase polymerase chain reaction (qRT-PCR) technique. Our results showed a significantly increased level of expression of pro-apoptotic factor Bax along with significantly higher Bax/Bcl-2 ratio in the patient group.n Conclusion: The results presented indicate that apoptosis could be one of the factors contributing to the lack of balanced bone remodeling process in Perthes patients.What is Known:•The etiology of Perthes disease is unknown. The role of genetic factors involved in the coagulation process has been studied, showing inconsistent results so far.•Genetic factors involved in inflammation and apoptotic processes that could contribute to development of hip deformity have not been studied extensively.What is New:•Our results show significantly increased level of expression of the pro-apoptotic factor Bax as well as significantly higher Bax/Bcl-2 ratios in patient group, indicating that apoptosis could be one of the factors contributing to the lack of a balanced bone remodeling process in Perthes patients.

Influence of the metabolic control on latency values of visual evoked potentials (VEP) in patients with diabetes mellitus type 1

The aim of our study was to investigate the relationship between the metabolic control parameters of diabetes mellitus (glycemia and HbA1c) and visual evoked potentials (VEP) latency values. The study included 61 patients with diabetes mellitus type 1 that were hospitalized at the Clinic for Endocrinology, Diabetes and Metabolic Diseases due to the poor metabolic control. All patients were divided into 3 groups. Group 1 consisted of patients on conventional insulin therapy (CT); Group 2 included patients on CT at the moment of hospitalization, with a change towards intensified insulin therapy (IIT); and Group 3 consisted of patients on IIT. Patients with diabetic retinopathy (DR) were excluded from the study. Metabolic control (glycemia and HbA1c) and VEP parameters were compared at the beginning of the study and six months later. After six months of strict glycoregulation, significant improvement in VEP parameters was followed by significant improvement of evaluated parameters of metabolic control. We found statistically significant reduction in frequency of pathological VEP findings, prolonged P100 latency and low amplitude potentials in Group 2, while in Groups 1 and 3 we found that these parameters did not significantly changed but the frequencies were lower. The VEP testing is a noninvasive diagnostic procedure which may help in early diagnosis of DR, prognosis during the metabolic control and treatment. If changes in the retina could be detected before DR is noticed using this noninvasive diagnostic procedure and include patients in a strict glycoregulation, we could be in the position to prevent serious complications that may cause blindness.

Basic principles of aggressive rehabilitation after anterior cruciate ligament reconstruction

Rehabilitation after ACL (anterior cruciate ligament) reconstruction has drastically changed over the last decade, with the adoption of a more aggressive approach, right from the first day after surgery. Progress in the effectiveness of rehabilitation is based on improvements in operative techniques, as well as on the encouraging results of histological studies regarding graft healing. Despite a huge amount of research papers on this topic, a rehabilitation golden standard still has not been established, due to the complexity of this problem. In this review, we point out the basic principles of rehabilitation after arthroscopically assisted ACL reconstruction based on actual practices, as well as the importance of specific procedures for the prevention of complications during the postoperative period. The importance of range-of-motion exercises, early weight bearing, an appropriate gait scheme, patella mobilisation, pain and oedema control, as well as stretching and balance exercises is explained. The functional advantages of closed kinetic chain exercises, as well as their influence on the graft are also described, in comparison to open kinetic chain exercises. The fundamentals of returning to sports are revealed and the specific aspects of rehabilitation regarding graft choice are pointed out. While waiting for new clinical investigations, which are expected to enable the establishment of a rehabilitation golden standard, the outlined principles should be followed. The complexity of this injury requires treatment in highly specialised institutions.

Periprosthetic Femoral Fractures in Total Knee Arthroplasty

Total joint arthroplasty has greatly improved the treatment of knee arthrosis, but still is not without complications. Supracondylar fractures above total knee replacements are an uncom‐ mon complication (incidence 0,3% to 2.5%), occuring more frequently in patients older than 60 years with osteoporotic bone. The rate of these fractures is expected to increase in the future because of the growing number of total knee replacements and greater level of acitivity among elderly patients. The timing of such fractures has been reported to range from early in the postoperative period to more than a decade after surgery, with a mean of 2 to 4 years. During the past two decades authors were not agreed in the definition of periprosthetic supracondylar region: the lower 3 inches (7cm) of the femur [1]; 9 cm proximal to the knee joint line [2]; all fractures within 15 cm proximal to the knee joint line [3]. Generally, based on the older literature, supracondylar periprosthetic fractures were those within 15 cm of the joint line, or in the case of stemmed component, within 5 cm of the proximal end of the implant. Never‐ theless, the most important is understanding that these fractures occur in regions of stress concentration adjacent to a prosthetic component, and that the presence of the prosthesis has a significant effect on fracture treatment. So, we suggest that fractures above total knee replacement should be considered supracondylar fractures if they extend within 7 cm of the prosthetic joint line or if they are within 2 cm of the femoral prosthetic flange.

Neurophysiological evaluation in newly diagnosed Diabetes Mellitus type 1

The aim of the study was to evaluate the effects of hyperglycemia on nerve conduction in patients with newly diagnosed diabetes mellitus type 1, and to investigate the significance of early electrophysiological diagnostics in these patients. The study included 85 newly disclosed patients with type 1 diabetes mellitus, in the first three months after the disease. Nerve conduction velocities (NCV) of further nerves were evaluated: median, peroneal, tibial and sural nerve as well as late responses (F-wave and H-reflex). Metabolic control parameters that were evaluated included: glycemia rate on the day of investigation and HbA1c. All patients had poor metabolic control parameters. We found NCV slowing predominantly in the tibial nerve (in 82.4% of patients). Prolonged F-wave latency was disclosed in 72.9% of patients, while H-reflex was evoked in 27.1% of patients only. The most sensitive parameter in the early neurophysiologic diagnostics was the measurement of F-wave latency. Our study underline the significance of early neurophysiological diagnosis, since hyperglycemia can play an acute role in NCV slowing, despite the absence of clinical symptoms, particularly in the first three months after the diagnosis has been confirmed.

Evaluation of neurophysiological parameters and good metabolic control in patients with type 1 diabetes mellitus

INTRODUCTIONnNumerous authors have indicated the beneficial effect of glycoregulation on micro- and macro-angiopathic complications.nnnOBJECTIVEnThe aim of the study was to examine whether intensive treatment with maintaining blood glucose concentrations close to normal range could improve electrophysiological parameters.nnnMETHODSnThe study involved 81 patients with type 1 diabetes mellitus type 1 randomly assigned to intensive insulin therapy. The patients were followed for a period of 3 months by metabolic and electrophysiological control. The metabolic control included daily measurement of concentration of blood glucose and HbA1c and lipid status, while the neurophysiological control included nerve conduction velocity (NCV) of median, peroneal, tibial and sural nerve and latency of F wave.nnnRESULTSnIn the beginning of our study blood glucose was 9.10 +/- 3.69 mmol/l and HbA1c 8.12 +/- 1.20%. After 3 months of administered intensive insulin therapy, blood glucose was 7.88 +/- 2.79 mmol/l and HbA1c 6.63 +/- 1.33. After 3 months NCV improved in the tibial, median and sural nerve (p < 0.05) and latency of F wave.nnnCONCLUSIONnWe found a significant association between the metabolic control and NCV findings which suggests that good metabolic control influences the improvement of neurophysiological parameters in patients with type 1 diabetes mellitus.