The Pelvic Support Osteotomy After Type IVA Septic Arthritis of the Hip.

INTRODUCTION: A misdiagnose and inadequate treatment of neonatal septic arthritis of the hip has multiple sequelae and causes a severe disability. The aim of this study is evaluation of treatment of residual deformity after type IVA neonatal septic arthritis of the hip by Pelvic support osteotomy. CASE PRESENTATION: A 11-year-old, white girl, was treated surgically by pelvic support osteotomy. The patient underwent two surgical interventions. The first operation consists in lengthening of the left femur for 6 cm with monolateral lengthening external fixation device. The second operation consists in pelvic support osteotomy of the left femur and lengthening for 4 cm. The limb was well aligned after healing, with the axis aligned under the medial wall of the acetabulum. CONCLUSION: Pelvic support osteotomy can successfully correct a Trendelenburg-Duchenne gait and simultaneously restore knee alignment and correct lower-extremity length discrepancy.

Role of meconium in the reaction of airways smooth musculature in the newborn with meconium aspiration syndrome (MAS).

The role of meconium in the respiratory system was studied in newborns, who died from various causes (250 up to 3000 g of weight). We monitored tracheal rings response to dopamine, serotonin and ethanol in different concentrations (dopamine: 0,05 mg/ml, 0,5 mg/ml, 5 mg/ml; serotonin (5-HT): 10-4, 10-3, 10-2, 10-1 mol/dm3; ethanol: 0,02 ml, 0,5 ml, 1,0 ml; 96%). Tracheal smooth musculature tonus (TSM) was examined in 48 tracheal preparations taken after the newborn exitus due to different reasons. Based on functional researche of isolated preparations of tracheas, it may be concluded that: aspiration of meconium has not changed the response of TSM to dopamine, serotonin and ethanol (p>0,1) in comparison with the control group, which have died due to different lung inflammatory processes (e.g. pneumonia, bronchopneumonia, atelectasis, cerebral hemorrhage). The results suggest that meconium does not potentiate the constricting action of dopamine, serotonin and ethanol in tracheobronchial system. Meconium causes mild relaxation of the TSM through a mechanism that is not intermediated by the products of cyclooxygenases (prostaglandins, prostacyclins) from the tracheal epithelium or proteins. Also, as it seems, the direct activity of many tested acids in the smooth musculature has no significant impact on increase of the airways tonus in MAS syndrome.

Action of propranolol in the reaction of smooth musculature of tracheal rings induced with acetylcholine, histamine, serotonin (5-HT) and prostaglandin (PGF2-alfa) in vitro and in vivo.

Actions of acetylcholine (ACh), histamines, serotonins (5-HT) and prostaglandins (PGF2-alfa) in concentrations of 10(-4), 10(-3), 10(-2) and 10(-1) mol/dm(3) were analyzed in vitro conditions in isolated specimens of tracheas of 24 pigs, 7 guinea pigs, and dead persons for different reasons (8), in the presence and without presence of propranolol. Whilst, research regarding actions of aerosolized histamines (10 mg, 1%, 2 min), in the presence and without the presence of aerosolized propranolol (20 mg, 2%, 2 min) was done in vivo in 6 healthy persons. Study results show that propranolol does not emphasize contraction of the airways smooth musculature as induced by ACh, histamine, 5-HT and PGF2-alfa in vitro conditions (p>0,1). Also, in vivo we found a non-significance of tracheal smooth musculature constriction (p>0,1).

Corrective osteotomy of distal radius malunion after IIIB open fracture: Palmar approach - Case report.

BACKGROUND: Despite the fact that distal radius fractures are the most common, open fractures are relatively uncommon. The aim of this study is to present the case with severe malunion of extra-articular left distal radius after open fracture grade IIIB (Gustillo). The treatment was done with open correctuve osteotomy and ostosynthesis with volar low profile plate. CASE PRESENTATION: A 32-years old man was admitted to our departement because of severely malunited left distal radius extra-articular metaphyseal fracture after treatment of an open fracture. He was primary treated in a Regional Hospital with irrigation, debridement, antimicrobial cover, and immediate skeletal management through fixation with Kirschner's wires. No external fixator was used. He developed volar metaphyseal angulation after loss of primary reduction of K-wires fixation; therefore it required corrective surgical treatment. Because of malunion, open corrective osteotomy and bone grafting of distal radius with volar plating were done. Follow-up 20 months after surgery show deformity correction of radial volar inclination, height, and restitution of distal radioulnar joint. CONCLUSION: This case report offers an informative overview on this uncommon case of distal radius open fracture malunion treated successfully with volar approach corrective osteotomy. Corrective surgery is the primary therapy of choice in the this case. This method have shown to be safe and effective in treatment of distal radius malunion with volar angulation.

Sequelae of neonatal septic arthritis of hip.

The aim of the study was evaluation of residual deformity after neonatal septic arthritis of the hip. The patient was operatively treated by intertrochanteric osteotomy of valgisation of 350 with anterotation of 10 degrees and extension 25 degrees at age of nine years because of leg length discrepancy, changes in the femoral neck, coxa vara, plana and breva. It was delay in diagnosis and failure to begin treatment promptly in the neonatal period. Delay in the diagnosis and the treatment of septic arthritis can result in disastrous complication like in this case report.

Treatment of neonatal septic arthritis sequelae of hip: a case report.

INTRODUCTION: The most serious complication of the septic arthritis of the hip in childhood and especially in newborns is the avascular necrosis of the femoral head. The aim of the study was evaluation of residual deformity after neonatal septic arthritis of the hip in a boy aged thirteen years. CASE PRESENTATION: A 13-year-old, white male, was operatively treated by intertrochanteric osteotomy of valgisation, anterotation and extension at age of twelve years because of leg length discrepancy, changes in the femoral neck, coxa vara, plana and breva. It was delay in diagnosis and failure to begin treatment promptly in the neonatal period. CONCLUSION: Valgus intertrochanteric osteotomy of the femur, moves the greater trochanter distally and laterally, tensioning the abductors muscles and improving their leverage.