Milan Mitkovic

Surgical treatment of osteoporotic fractures

The world’s older population continues to grow at an extraordinary rate. Thus orthopedic and traumatology surgeons are faced with an ascending rate of osteoporotic fractures. Mechanism of injury in osteoporotic fractures is presented as low energy trauma or as a spontaneous occurrence. Fixation of these fractures is considered as a challenge and there are several implant types used for this purpose – endoprosthetic implants, locking plates with screws and redesigned intramedullary nails for different types of fractures . External fixation also has a role in the treatment of osteoporotic fractures. Authors of this paper have a good experience with the use of Mitkovic type Selfdynamysable Internal Fixator, especially in the treatment of osteoporotic proximal, diaphyseal and distal femoral fractures and of periprosthetic femoral fractures after hip or knee arthroplasty .

Application of the New Self-dynamisable Internal Fixator in the Treatment of Femoral Shaft Fractures

Summary The aim of this study was to present the results of one original method application in internal fixation of long bones. The series of 27 patients with unilateral fractures of femoral shaft was analyzed. According to AO classification, 21 fractures were classified as 32A, five as 32B, and one as 32C type. Original diaphyseal self-dynamisable internal fixator (model 1) was used as a fixation implant, consisting of three components: specially designed extramedullary bar, clamps and screws. The main feature of this implant is a possibility to become dynamic in the axial direction spontaneously if there is no sufficient fracture healing. Because of that, this implant is known as an „intelligent implant“. Surgical method included a standard surgical approach and minimally invasive surgical approach. Minimally invasive technique of application required less blood transfusion and shorter surgery time when compared to the standard surgical approach. The duration of used intraoperative fluoroscopy control was 7(3-18) seconds. The average healing time was 4.3 (3.5-9.5) months. There were neither intra operative nor postoperative complications. In comparison to intramedullary nails, self-dynamisable internal fixator provides a similar treatment results, while in comparison to plates it provides fewer mechanical complications. Self-dynamisable internal fixator method preserves periosteal and intramedullary blood circulation, and it is the first fixation implant with a possibility of spontaneous axial dynamising activation when needed. This implant has been proven as suitable for routine use in the treatment of femoral shaft fractures.

Surgical Treatment of an Open Elbow Dislocation with Vascular Injury: A Case Report

Summary Open elbow dislocations with vascular injury are rare injuries and they most commonly occur after a fall from a high or in sports accidents. Close anatomic proximity of the joint to the neurovascular structures put them at risk of concomitant injury. The aim of this paper is to present the method of treatment of this severe injury. Herein we present a case of a female patient, 43 years old. She had suffered an open elbow dislocation with vascular injury as a result of a fall from the height of 1.5 meters. Seven hours after sustaining the injury and short preoperative preparation, reposition of the elbow, reconstruction of the vascular injury, adequate surgical treatment of the wound and external fixation of the elbow with the Mitković type external fixator were performed under general anesthesia. Four weeks after elbow stabilization with the external fixation, the external fixator was removed. The neurovascular status and final functional result of the treatment after six mounts were good. Urgent reposition, artery and vein reconstruction, and external fixation are essential in achieving good results in patients with open cubital dislocation accompanied with vascular injury. The Mitković type external fixator provides fast and stable fixation of the elbow after reposition and good conditions for wound care.