Nemanja Slavkovic

Acute patellar dislocation in adolescents: operative versus nonoperative treatment

PurposeThe purpose of this prospective non-randomised study was to compare the efficacy of two opposed methods, operative and conservative. Our hypothesis was that if the method was selected correctly, on an individual basis, the results should be approximately equal.MethodsThe study included 37 adolescents aged between 12 and 16 years, with a mean follow up of 6.1 years. The presence of a significant loose body, confirmed by precise imaging, was the key for selecting operative or arthroscopic treatment. In both groups of patients, we evaluated functional knee scores and the incidence of residual patellofemoral disorders.ResultsWe confirmed our hypothesis using the t-test to compare functional results and a test for comparison of proportions for incidence of residual disorders. There was no statistically significant difference (p=0.091) between operatively and conservatively treated groups with regard to functional results. The same statistical outcome emerged when comparing incidences of re-dislocation (p=0.854), or other major patellar instabilities (p=0.856), between the groups.ConclusionsThe results obtained should not promote a non-operative method on the basis of lower risk, but do support an individual approach based on precise diagnosis and defined criteria.

Foot examination in the period of development.

Feet are maybe the key part of our musculoskeletal system that establishes upright position and movement. Their role is multiple--they maintain the balance of the body, push the body forward when walking and absorb mechanical pressure created in contact with the surface. Therefore, correct anatomic and functional development of foot is of vital importance. The most frequent reasons for examination of foot in the period of development are pain, deformity and incorrect walk. Our task is to detect the cause of the problem with clinical examination in the shortest possible period of time or to assess which additional diagnostic procedure would be the most suitable. A clinical examination of foot in the period of development involves inspection, palpation, percussion, auscultation, examination of joint mobility, examination of sensory-motor function and conducting specific tests. In some cases detailed and properly conducted clinical examination can prove to be sufficient to establish a complete and accurate diagnosis. Patients of this specific age may be insufficiently cooperative, mistrustful, shy or even afraid. Our approach and manipulations during the clinical examination need to be adapted completely to such patients and their characteristics.