Goran Cobeljic

Current diagnosis and treatment of the osteoarticular tuberculosis

In 1993, tuberculosis was recognized as global medical problem by WHO. Recurring flare-up of this disease was triggered by difficult socioeconomic situation of the countries in transition, current development of immunocompromising diseases, and some other factors have contributed, too. The osteoarticular tuberculosis has been always postprimary and localized form of the disease, which, due to certain similarity to some other osteoarticular diseases, has been challenge for orthopaedic surgeons both from diagnostic and treatment aspects. Bacteriological diagnostics has had a limited value due to application of recommended tuberculostatic medication before obtaining specimens from bones or joints; and, on the other hand, rapid bacteriological methods, because of their expensive equipment, could be carried out in large mycobacteriology laboratories only. New visualizing methods, CT and MRI, have been particularly important for detection and monitoring of tuberculosis process in the spine during the early stage of the disease, what is impossible to achieve with native radiograms. Programmed administration of tuberculostatic drugs both in non-operative and surgical treatment has been proven necessary.

The results of surgical treatment for pronation deformities of the forearm in cerebral palsy after a mean follow-up of 17.5 years

AimThis study evaluates the effects of three surgical procedures in the treatment of pronation deformities of the forearm in cerebral palsy patients; namely the transposition of pronator teres to extensor carpi radialis brevis muscle; and rerouting of the pronator teres muscle with or without pronator quadratus muscle myotomy.MethodsSixty-one patients, 48 male/13 female, with a mean age of 17 years (5–41 years) were treated between 1971 and 2011. Pronator teres transposition was performed in 10, pronator rerouting in 35, and pronator rereouting with pronator quadratus myotomy in 16 patients. Ranges of motion, and assessments using the Quick Dash, Mayo Scoring, and Functional Classification system of upper extremity, were made before and after surgery. Mean follow-up was 17.5 years (3–41 years).ResultsAll three procedures led to significantly improved ranges of motion and upper limb function, with good/excellent results in 80 % of patients. Mean active supination improved from 10 ° (0–60 °) to 85 ° (30–90 °) (p < 0.001). There were significant improvements in Functional Classification system for the upper extremity scores (p < 0.003), Mean Quick Dash Scores improved from 58.41 (38.63–79.54) to 44.59 (27.27–68.18), and mean MEPS improved from 68 (30–85) to 84 (60–100) following surgery. All three techniques had statistically improved MEPS following surgery (p < 0.001); only the pronator teres muscle rerouting with pronator quadratus myotomy showed an improved Functional Classification system for the upper extremity score (p < 0.05); and only the pronator teres rerouting procedure showed an improved Quick Dash score (p < 0.05). There were no statistically significant differences in outcomes between different ages groups, and no significant differences between isolated pronator teres muscle rerouting were compared with those undergoing simultaneous treatment of carpal flexion and thumb adduction deformities (p > 0.05).ConclusionSurgery is very effective in the management of pronation deformities of the forearm in patients with cerebral palsy. Isolated pronator teres rerouting is probably the most effective and simple technique. Adjunctive pronator quadratus myotomy does not lead to an improvement in the results and requires an additional surgical approach. There should be no age restriction to surgery, as all age groups appear to benefit from similar improvements in range of motion and upper limb function.

Efekti sekcije lateralnih retinakula kolena u operativnom lečenju simptomatske patelofemoralne inkongruencije

Biomechanical malfunction of the knee extensor mechanism in the patello femoral joint is regarded as patella malalignment but major patients complaints are anterior knee pain and patellar slipping. Lateral retinacular release is one of the basic surgical procedures in the treatment of patellar malalignment. The aim of the study was to estimate the achievements of the lateral retinacular release in solving particular biomechanical disorders of the patello femoral joint, as well as individual patients complaints. Evaluation of objective parameters x-ray and clinical findings before and after the operation, shows statistically highly significant difference, thus confirming implementation of the fore mentioned surgical procedure. Despite the fact that anterior knee pain subsided postoperatively in the number of patients, statistically significant values, comparing to the preoperative findings, could not be obtained. Incidence of the patellar slipping has shown statistically significant reduction two years following the surgery. Achieving proper biomechanical alignment of the patello femoral joint is obviously not sufficient to provide relief of subjective complaints, especially concerning anterior knee pain, although considerable improvements were registered in the number of patients.