Sasa Milenkovic

Validation of the osteoporosis quality of life questionnaire QUALEFFO-41 for the Serbian population

BackgroundVertebral fractures could lead to reduced physical, social and mental functioning, and loss of personal independence. Therefore, during the treatment of osteoporosis, it has become necessary to examine the changes in everyday functioning, well-being and health related quality of life (HRQOL). To that effect, this study aims to translate, culturally adapt, and validate the Serbian version of Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO-41) for patients with vertebral fractures.MethodsNine female patients with osteoporosis participated in the pre-validation study. A validation, case–control study included two groups of female patients: one that consisted of 50 female patients with osteoporosis, and with at least one vertebral fracture, and another one that consisted of 50 control patients with osteoporosis but without fractures. They completed the QUALEFFO-41 and the EuroQol group questionnaire with five dimensions (EQ-5D) twice within a month. The validation study examined internal consistency, concurrent validity, test-retest reliability, sensitivity and specificity.ResultsDuring the pre-validation study, three of the items in the QUALEFFO-41 were slightly changed. Afterwards, during the validation study, the statistically significant differences (adjusted for: age, duration of menopause, current employment and marital status) in the mean values of all domains and total scores between the groups were noted. For the case group, the internal consistency of the QUALEFFO-41 domains and of total questionnaire was above 0.70. The test-retest reliability was tested by the intraclass correlation coefficients (ICC) that were in range 0.87 – 0.96 for the case, and 0.15 – 0.83 for the control group. Correlations between the total scores of the QUALEFFO-41 and the EQ-5D health state value, for both groups were negative and statistically significant (r = -0.78, p<0.001 and r = -0.73, p<0.001, respectively). The QUALEFFO-41 had a better prediction of the value of HRQOL of cases compared to the generic questionnaire EQ-5D (the AUC difference was 0.099, p = 0.013).ConclusionsThe Serbian QUALEFFO-41 version is reliable, valid, sensitive and predictive for examinations of HRQOL in patients with prevalent vertebral fractures and can be used in further studies.

Open subtalar dislocation treated by distractional external fixation

Summary: Subtalar dislocation is a rare injury, constituting approximately 1% of acute dislocations, and often is the result of high-energy trauma, particularly falls from heights. We present a case of a 33-year-old man who sustained a Gustilo type IIIB open subtalar dislocation when he fell 4 m from a scaffold. After irrigation and debridement, a Mitkovic distractional external fixator was applied medially for 6 weeks while the wound healed by secondary intention. Physical therapy was initiated along with partial to full weight bearing during the next 3 months. The patient returned to work at 8 months postinjury. At 24 months, the patient had a normal gait with pain only during prolonged periods of standing or walking. X-rays and MRI were normal with no signs of avascular necrosis or posttraumatic arthritis. Ankle joint range of motion was dorsiflexion 5° and plantar flexion 45° with moderately limited subtalar joint motion. The distractional external fixator allowed for complete wound care and unburdening of the talus, which perhaps reduced the possibility of avascular necrosis.

Relation between bone density and certain parameters of lipid status in postmenopausal women

The aim of the paper was to examine the relation between bone density and certain parameters of lipid status in postmenopausal women. The research involved 300 women referred to densitometric examination as they belonged to the risk group of postmenopausal women. All the examinees had the following biochemical parameters determined: total cholesterol, triglycerides, HDL cholesterol, LDL cholesterol, glycemia, serum Ca and P. Univariate logistic regression analyses showed that each year of age, menopause duration, AH are significantly connected to risk increase for the appearance of osteopenia or osteoporosis. Increase in values of SBP, DBP, cholesterol, LDL and triglyceride are connected with significant risk increase for the appearance of osteopenia or osteoporosis. Patients with AH are connected to 11 times elevated risk for the appearance of osteopenia or osteoporosis, cigarette smoking increased the risk by seven times, physical inactivity even by 52 times, CVD in the family anamnesis by eight times, and osteoporosis in the family anamnesis is connected to the risk by four times. In our research, atherogenic lipoproteins negatively correlate with lumbar bone density. Disturbed lipide status is a risk factor for cardiovascular diseases, but also a risk factor for the appearance of osteoporosis.

Relation between bone mineral density and IL-17 serum levels in Serbian patients with early Rheumatoid arthritis

Abstract Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by synovial inflammation and destruction of joint cartilage and bone. Different cytokines play important role in the processes that cause articular destruction and extra-articular manifestations in RA. The contribution of cytokines representing the Th1 (INF-γ), Th2 (IL-4) and IL-17A to the pathogenesis of early RA and bone mineral density (BMD) loss in still poorly understood. Serum samples of 38 early RA patients were evaluated for erythrocyte sedimentation rate (ESR), rheumatoid factor (RF), C-reactive protein (CRP), anti-cyclic citrullinated peptide antibodies (anti-CCP) and for the tested cytokines (IL-17A, IL-4 and INF-γ). BMD was evaluated by dualenergyX-ray absorptiometry (DXA). Disease activity score (DAS28) calculation was assessed for all patients. Control serum samples were obtained from 34 healthy volunteers. The levels of tested cytokines were significantly higher (IL-17A, p<0.001; INF-γ, P<0.001; IL-4, P<0.01) in patients with early RA, compared to the healthy controls. In early RA patients, strong correlation of serum IL-17A was found with DAS28, ESR and CRP. Also, a significant negative correlation was found between serum INF-γ levels and the DAS28 score. Significantly positive correlation of BMD values and CRP, DAS28 IL-17A were also demonstrated. DXA analysis revealed that the most common site for osteoporosis was the lumbar spine followed by the femoral neck. BMD values significantly correlated with CRP, DAS28 score and IL-17A serum levels. The mean serum IL-17A levels, in patients with early RA, corresponded with disease activity, severity and BMD loss, indicating the potential usefulness of serum IL-17A in defining the disease activity and bone remodeling.

Late Diagnosed Cervical Spine TBC Spondylitis: Case Report

SUMMARY Cervical tuberculosis is a rare disease with a high complication rate. Tuberculosis of the cervical spine is reported in about 6-9% of all cases of spinal tuberculosis. Early diagnosis and treatment of spinal tuberculosis is essential in order to prevent neural deficit. Management strategies for spinal tuberculosis range from ambulatory chemotherapy to radical surgical debridement with fusion. The paper presents a case of an 18-year-old patient with TBC spondylitis C3- C5. Eleven months passed from the onset of the disease until surgery and final diagnosis. When hospitalized, the patient suffered from the overall weakness, a 15- kg weight loss, dysphagia, neck pain, neck rigidity, febrility, cervical radiculopathy and paresthesia of both upper extremities. MR image showed a complete destruction of C3, abscess perforation in the anterior epidural space with the spinal cord compression and abscess extension to prevertebral space from C2 to C5. After the radical surgical debridement of C3-C5 and anterior decompression, a tricorticate autologous bone graft obtained from the iliac crest was placed and a plate fixation was done. Tuberculostatics were included for 12 months after surgery. Complete recovery occurred six months after surgery. Anterior decompression with autologous iliac bone graft led to a good clinical and radiological outcome in patients with cervical spine tuberculosis. Sažetak Tuberkuloza vrata je retka bolest, sa visokom stopom komplikacija. Tuberkuloza vratne kičme je opisana u 6-9% slučajeva spinalne tuberkuloze. Rana dijagnoza i tretman tuberkuloze kičme neophodni su da bi se sprečio neurološki deficit. Strategija tuberkuloze kičme se kreće od ambulantne hemoterapije do radikalnog hirurškog debridmana sa fuzijom. Prikazujemo slučaj bolesnika, starosti 18 godina, sa tuberkulozom vratne kičme C3-C5. Od početka bolesti do operacije i postavljanja dijagnoze prošlo je 11 meseci. Do hospitalizacije, bolesnik je izgubio na težini 15 kg, imao je teškoće pri gutanju, bolove u vratu, ukočenost vrata, povišenu telesnu temperaturu, vratnu radikulopatiju i osećaj trnjenja u gornjim ekstremitetima. MRI nalaz je pokazao kompletnu destrukciju C3 vratnog pršljena, prodor hladnog apscesa u prednji epiduralni prostor, sa kompresijom na kičmenu moždinu i širenjem apscesa u prevertebralni prostor od C2 do C5 vratnog pršljena. Posle radikalnog hirurškog debridmana C3-C5 i prednje dekompresije, plasiran je trikortikalni autologni koštani grefon sa ilijačne kriste i urađena je fiksacija pločom. Uključeni su tuberkulostatici u trajanju do 12 meseci od operacije. Kompletan oporavak nastupio je 6 meseci posle operacije. Prednja dekompresija sa autolognim koštanim grefonom sa ilijačne kriste vodi ka dobrom kliničkom i radiološkom rezultatu kod bolesnika sa vratnom tuberkulozom kičme.

External fixator by Mitkovic in the treatment of comminuted intraarticular fractures of the distal radius

INTRODUCTION Comminuted intraarticular fractures of the distal radius metaphysis are a major challenge for orthopedic surgeons. The aim of this study was to present results of the survey on treatment of these fractures using an external fixator. MATERIAL AND METHODS 73 patients (30 females and 43 males) with closed comminuted intraarticular fractures of the distal radius, type C AO/ASIF (based on radiography at the moment of injury) were treated by a Mitkovic external fixator and followed-up for at least 2 years. An external fixator and Kirschner wires were used in 43 patients. An external fixator without Kirschner wires was used in 30 patients. RESULTS At the end of treatment, functional results and outcomes were excellent in 39 (53.4%), good in 19 (26%), fair in 10 (13.7%), and poor in 5 (6.8%) patients according to Jakim score. Lesser degree of limitation of the movement of the wrist joint was established in 19 patients (26%). Joint incongruity of the distal radius, 0-2 mm, was observed in 22 patients (30%) and over 2 mm in 3 patients. A minimal degree of posttraumatic osteoarthrosis was recorded in 21 patients (28.7%) and moderate ostheoarthrosis in 5 patients (6.8%). CONCLUSION The anatomic reduction of the articular surfaces and healing of the fracture in a proper functional position are prerequisites for adequate function of the wrist and hand. It appears that an external fixator, with or without Kirschner wires, can be a method of choice in treatment of these complex articular fractures.

Operation time and intraoperative fluoroscopy time in different internal fixation methods for subtrochanteric fractures treatment

* Accepted papers are articles in press that have gone through due peer review process and have been accepted for publication by the Editorial Board of the Serbian Archives of Medicine. They have not yet been copy edited and/or formatted in the publication house style, and the text may be changed before the final publication. Although accepted papers do not yet have all the accompanying bibliographic details available, they can already be cited using the year of online publication and the DOI, as follows: the author’s last name and initial of the first name, article title, journal title, online first publication month and year, and the DOI; e.g.: Petrović P, Jovanović J. The title of the article. Srp Arh Celok Lek. Online First, February 2017. When the final article is assigned to volumes/issues of the journal, the Article in Press version will be removed and the final version will appear in the associated published volumes/issues of the journal. The date the article was made available online first will be carried over.

TOTAL HIP REPLACEMENT REHABILITATION: RESULTS AND DILEMMAS

The number of candidates for total hip replacement (THR) is steadily increasing. Judging by the clinical results and implant longevity, THR is one of the most common and most successful orthopedic interventions of all times. Material, design, surgical techniques and subsequent rehabilitation continue to evolve. Choice of the prosthesis and fixation technique depends on the patients’ bone structure and joint stability and their individual characteristics, such as age, weight and level of activity. Rehabilitation after THR is as important as the surgery. Rehabilitation protocols vary with the type of endoprosthesis. There is some controversial evidence about the differences in the surgical approach, the role of the preoperative education and exercises, as well as the implementation of the most efficient rehabilitation protocol. Despite many uncertainties and dilemmas, most studies have shown that majority of patients are satisfied with their arthroplasty results. Acta Medica Medianae 2018;57(1):48-53.

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.