Comparative analysis of the effects of dalteparin and reviparin on perioperative blood loss in patients with extracapsular hip fractures treated with intramedullary nailing.

Aim To determine differences between reviparin and dalteparin treatment in patients with extracapsular hip fractures treated with intramedullary nailing and their effects on perioperative blood loss and early postoperative recovery. Methods Retrospective comparative study included 68 patients with extracapsular hip fracture who were divided into dalteparin and reviparin group. Medical records were used to obtain demographic data, laboratory parameters, haemoglobin and haematocrit levels, platelet count, mortality rate and medical complications. Results Out of total 68 patients, 31 were in reviparin and 37 in dalteparin group. Mean age of patients was 70.5 (±14.4) and 76.8 (±8.4) years in reviparin and dalteparin group, respectively (p=0.071). Median values of haemoglobin levels on the first postoperative day were lower in dalteparin group compared to reviparin group (p=0.012). On the first postoperative day haematocrit values were also lower in dalteparin than in reviparin group (p=0.015). Both groups showed an increase in platelet count on the first postoperative day, but without significant difference (p=0.084). There was no statistically significant difference in intrahospital mortality between the groups (6.4% vs. 2.7%; p=0.588). One case of pulmonary embolism was detected in the dalteparin group. Conclusion Low-molecular-weight heparin is the drug of choice in patients with hip fractures for thromboprophylaxis. Due to non-antithrombin-mediated actions, reviparin and dalteparin could have different effects on perioperative blood loss. Both dalteparin and reviparin are safe and effective agents for thromboprophylaxis in patients with proximal femur fractures.

Early results of the conservative treatment of distal radius fractures-immobilization of the wrist in dorsal versus palmar flexion.

Aim To evaluate immobilization with dorsal forearm plaster splint with the wrist in dorsal flexion vs palmar flexion in patients with distal radius fracture. Methods In the prospective study (2012-2014) 122 patients (of which 22 patients lost) with fractures of the distal radius type A2, A3 and C according to the AO classification were investigated. At the end there were 50 patients in each of the two groups: the dorsiflexion (DF) group had a total of 37 women and 13 men, mean age was 63.48 ± 14.70, and in the palmar flexion (PF) group there were respectively 38/12, and the mean age was 64.20 ± 12.99. In both groups measurements of radiological, clinical and functional parameters were conducted. Patient related wrist evaluation survey (PRWE) and SF12 questionnaire were used for evaluation of pain and function of the wrist and physical and mental condition, respectively. Results The study showed excellent results in both groups but there was significant improvement in the range of motion (ROM) on every measurement in the DF group: dorsal flexion 47.70±15.29; ulnar deviation 24.10±7.80; radial deviation 11.50±5.65 vs PF 22.80±19.04; 16.00± 9.31; 4.80± 494 (p<0.001). Also, radiological parameters showed significant improvement until the end of the follow-up. Functional parameters showed significant improvement of physical component of SF-12 in the DF group (p<0.014). Conclusion Immobilization with forearm plaster splint on the dorsal side and with the wrist in dorsiflexion gives better early clinical, radiological and functional results in patients with fractures of type A2, A3, C1-3 in patients of all age groups, compared to immobilization with the wrist in palmar flexion.

Wrist instability after injury.

Fractures of the bones that make the wrist joint together with injury to the ligaments and joint capsules are frequent traumas. It can cause besides limited movement also the pathological mobility. These mild injuries often do not provide the degree of recognizable symptoms and signs. They are diagnosed by X-ray imaging, stress images. Before arthrography was an important method, but nowadays arthroscopy has the advantage. Fresh bone and ligament injuries can be and should be repaired in the early posttraumatic period. Unrecognized and undiagnosed injuries are leading to instability of the wrist, to motion abnormalities or impingement overload syndrome. In the treatment of instability important place have reconstruction of the ligaments and arthrodesis of the wrist.

Use of multislice computed tomography in radiological treatment of patients with hip pathology.

In this paper we are presenting the application of Multislice CT Scan (MSCT) as a part of radiological treatment in a female patient with avascular necrosis of head and neck of the right femur, which occurred as a consequence of developmental hip dysplasia. The left hip joint of the patient was previously replaced by a prosthetic implant.

[The Kramer osteotomy in the treatment of hallux valgus]. / Lijecenje Hallux valgusa osteotomijom prve kosti metatarzusa po Krameru.

In 1973. J. Kramer published his own technique for the cure of hallux valgus (Orthopädische Praxis Heft 8/1982, 636-645). He corrects bad position of the first bone of the metatarsus with all the consequences which lie in the basis of the deformation. By osteotomy of the first bone of the metatarsus and re-instates functional equipise of the first foot instep in all the components. Having the experience of 550 operated patients he considered that this method has advantages over numerous described method, indicative range is practically wide, respecting the technique it is simply performed, post-operative cure does not require immobilisation, and in comparison with other methods, complications and bad results are practically unknown. On our ward, in the period between 1984 and 1988, we applied Kramer's osteotomy in 98 cases of hallux valgus. The results were satisfying, considerably better than after other methods of hallux valgus treatment.