Srdjan Ninkovic

Femoral guide breakage during the anteromedial portal technique used for ACL reconstruction

Positioning of the femoral tunnel is very important in ACL reconstruction and it is often recommended to use an anteromedial portal technique in order to create the tunnel. This technique is more demanding but it gives a surgeon more freedom to place the ACL graft in an anatomical position compared to the transtibial technique. A case of an intraarticular femoral guide breakage associated with this particular technique is presented. That being said, the aim of this paper is not only to present this rare complication following arthroscopic reconstruction of ACL, but also to indicate how to prevent, diagnose and treat this undesired event.

Abscess of C1/C2 cervical vertebrae - errors in diagnosis and therapy

Abscess of C1/C2 cervical vertebrae - errors in diagnosis and therapy Background. Nonspecific upper cervical spine vertebra osteomyelitis is very rare. It is caused most often by contiguous spread from an adjacent focus of infection and rarely by haematogenous dissemination from an extraspinal one. We present a rare case of Coagulase-negative Stahylococcus spp cervical vertebra osteomyelitis, where the clinical presentation of the disease is often atypical. Case report. We analysed the case of 57-year-old female, where we found the diagnostic error in identification of the atlas subluxation on the radiograph and neglected laboratory findings indicating the urinary infection. These led to the disease progression and occurrence of neurological sympthomatology, presented with tetraparesis. A prompt surgery in two steps was planned: the urgent surgical anterior decompression and then the occipitocervical fixation, but the patient died after the first surgical session. Conclusions. The early recognition of symptoms and a prompt diagnosis are always essential for the onset of the accurate therapy. An additional destabilization of the affected segment done by the surgical decompression in the fist step without the adequate stabilization may lead, as shown here, to a sudden fatal outcome.

Bone tunnel enlargement after the reconstruction of anterior cruciate ligament using BTB graft

Background/Aim. Bone-tendon-bone (BTB) graft is one of the strongest biological grafts and it provides a strong initial fixation with the application of interference screws making possible the primary bone healing and bone integration of the graft on the place of fixation during arthroscopic reconstruction of the arterior cruciate ligament of the knee. The aim of our research was to determine if BTB graft from which, throughout the surgical treatment, soft tissue and periosteum are removed, leads to the reduction of the enlargement in the femoral and tibial bone after the arthroscopic reconstruction of the anterior cruciate ligament. Methods. The first phase consisted of bio-mechanical study on 12 pairs of cadaveric BTB grafts. The testing was performed on the mechanical testing machine. The second phase involved clinical testing. The first group consisted of 40 patients treated with the classical BTB autograft. The second group consisted of 56 patients who had two thirds of the bony parts of the bone-tendon-bone autografts of the soft tissue and periosteum removed. We measured the distance between the edge of the sclerotic tunnel on the tibial and femoral bone in three different points: proximal (F1;T1), middle (F2;T2) and the lower part (F3;T3). Results. The experimental part of the study showed no statistically significant difference in graft breakout force expressed in N/mm2 between classically treated BTB graft and graft with a partially removed soft tissue and periosteum. By comparing the expansion of tunnels in all segments in both bone tunnels between study groups, statistically significantly lower enlargement was measured in the group with BTB grafts with partially removed soft tissues and periosteum (p < 0.05). Conclusion. The use of BTB grafts with partially removed soft tissues and periosteum provides less bone tunnel expansion as compared to classically treated grafts of the anterior cruciate tendon.