Use of ultrasonography in evaluation of new bone formation in patients treated by the method of Ilizarov.

BACKGROUND: Lengthening of bones by gradually distracting bone fragments using an external apparatus by Ilizarov, is a long process with numerous complications. The greatest threats in limb lengthening are poor new bone formation as well as premature consolidation of the newly generated bone. The purpose of this study was to determine the importance of ultrasonography in evaluation of bone formation in limb lengthening. PATIENTS AND METHODS: The study involved 31 patients, in whom 52 long bones were lengthened by the Ilizarov method at the University Clinic for Orthopaedic Surgery in Skopje from 2006 to 2010. The study revealed the results of ultrasonographic analysis of new bone formation at four various stages of limb lengthening. The analysis of the results of ultrasonographic examination of bones throughout the lengthening process was based on the form and dimensions of the obtained ultrasonographic parameters--indicators of new bone formation--as well as on the appearance of the cortical margin at the distraction site. RESULTS: Tiny, solitary and confluent hypo-echogenic foci developed on sonograms approximately 2 weeks after distraction was commenced. At stage I a new cortical margin was detected in 30.77%. The number of initial small indicators significantly decreased throughout lengthening. At stage IV the solitary indicators rate was 9.51%, whereas the linear indicators rate significantly increased from 22.12% at the first stage to 54.3% at the last stage. the cortical margin was presented in all 52 bones at III and IV stage of lengthening. DISCUSSION AND CONCLUSIONS: Ultrasonography enabled an evaluation of the degree of new bone formation and it preceded the radiographic changes at the distraction site. This helped to determine the surgical lengthening and to avoid numerous complications.

Significance of ultrasound in the diagnosis and treatment of achilles tendon rupture.

UNLABELLED: The aim of this study is to show the importance of ultrasound method in the diagnosis of Achilles tendon rupture, the choice of method of treatment and monitoring of treatment using the same method. MATERIAL AND METHODS: Between 1999 and 2009, 134 patients with Achilles tendon rupture were referred to our Clinic. 66 patients (with a mean age of 38 years) were treated with surgical suture followed by plaster immobilization for a period of 8 weeks. 68 patients (with a mean age of 42 years) were treated conservatively with plaster immobilization for a period of 8 weeks. The follow-up in both groups of patients was 2 years. RESULTS: During the clinical and ultrasound monitoring of the patients it was proved that repeated rupture of the same tendon occurs on average within 12 months. Return to sports activities showed in 57% of the conservatively treated patients and in 55% of surgically treated patients. The patients with Achilles tendon rupture were treated at our Clinic with previously standardized protocol which, besides the clinical examination, used the ultrasound method. SUMMARY: Ultrasound examination is a very important method in the diagnosis and the choice of the method of treatment, as well as in the evaluation of results in patients with Achilles tendon rupture, either in operative or conservative treatment.

Prevention, management and rehabilitation of patients with cerebral palsy.

UNLABELLED: The aim of this paper is to present the importance of orthopaedics in the prevention, treatment and rehabilitation of persons with cerebral palsy. MATERIAL AND METHODS: The paper is based on a study realized at the University Orthopaedic Clinic, Medical School, Ss. Cyril and Methodius University in Skopje, with application of documentary analysis, observation and clinical analysis of 76 patients with cerebral palsy, aged between 1 and 15 years. RESULTS: Orthopaedics is a surgical field of medicine, in which context there have been, are and will be, as a challenge, many questions for the present and future generations. Data analysis pointed out that surgical treatment in combination with conservative treatment give a hope that a definite or prolonged cure is possible, with maximal and possibly preserved function of the loco-motor system or, in the most serious cases, abatement of the impaired locomotor system symptoms. SUMMARY: Early diagnosis and appropriate application of surgical treatment enable better functioning of persons with cerebral palsy by maximal exploitation of their remaining abilities.

The role of clinical diagnosis in meniscal lesions of the knee.

The aim of the present paper is to evaluate the importance of clinical examination in the process of diagnosing meniscal lesions, as well as to establish the accuracy of clinical examination in comparison to the arthroscopic diagnosis. In the last 5 years, in the Orthopedic Surgery Clinic in Skopje, the authors have diagnosed and treated 205 patients suffering from meniscal lesions. The method of anamnestic testing, and of clinical examination and the statistical method have been applied. All the patients were subjected to the following tests: well taken anamnesis of the knee injury mechanism, standard orthopedic examination (Stainman I and II, McMurray and Appley test), standard radiographic images of the knee, additional examination with MRI for some of the patients and arthroscopic examination. The results obtained with clinically established diagnosis were compared to the results obtained with arthroscopic diagnosis. Comparing the results of the clinical and arthroscopic diagnoses, an insufficiency of the clinical diagnosis of almost 20% was established. The results are close to those given in the professional literature which refers to the standardized approach in taking the anamnestic data and the realization of the physical signs and tests examination technique. It means that the physical signs and tests, as well as the well-taken anamnesis, are the foundation for establishing a diagnosis of meniscal lesions. Arthroscopy is truly the only golden standard for the diagnosis of all entities of the knee joint, including meniscal lesions.

Clinical and radiographic analysis of the operative procedure results according to the method of Mitchell and Keller used for correction of hallux valgus deformities.

UNLABELLED: The aim of this study is to make a correlation of the clinical and radiographic results after performing two different surgical procedures for correction of hallux valgus deformity. MATERIAL AND METHODS: The study included 70 patients having hallux valgus deformity of the foot, and they were divided into two groups. The first group (Group 1) was composed of 35 patients who were treated by osteotomy of the I-st metatarsal bone according to Mitchell, while the second group (Group 2) was also composed of 35 patients who were treated by resectional arthroplasty according to Keller. Clinical (pain and metatarsalgia, as well as most dominant symptoms) and radiographic examinations (I metatarsophalangeal angle and I intermetatarsal angle) were analysed comparatively during the evaluation. The analysis of the clinical and radiographic results was performed pre-operatively and post-operatively for the two groups. RESULTS: According to their sex, the patients were 5 men and 65 women. Using the method of Mitchell, pain as a clinical symptom post-operatively was found in only 3 patients out of the 35 with operated feet, while in the other group of patients treated by the method of Keller, there was no presence of pain in any of the patients. Comparatively, this does not present a statistically significant difference (p>0.05). Nor do, the differences in the distribution of metatrsalgia incidence show a statistical significance between the two groups (p>0.05). There is no significant difference (p>0.05) in the patients of the two groups concerning the pre-operative mean dimension values of the I metatarsophalangeal angle and I intermetatarsal angle. However, the radiographic analysis of the same angles in both groups, one year post-operatively, showed a high statistically significant difference (p<0.001). SUMMARY: Mitchell's operative technique could be recommended as an effective procedure for the correction of hallux valgus and metatarsus primus varus in young and middle-aged patients, while the resection arthroplasty according to the method of Keller is recommended for older patients with arthrotic changes.

Kinematic radiographic measurements of the wrist in the healthy population in the Republic of Macedonia.

Many diseases of the wrist can be recognized by radiographic changes and quantified by radiographic measurements. The kinematic radiographic measurements are the basis for kinematic studies of the wrist as well as a diagnostic, prognostic and follow- up tool for many conditions of the wrist. We undertook this study to identify the normal variations in the longitudinal and transverse dimensions of the wrist, and measure several indices on posteroanterior roentgenograms of the wrists of the healthy population in the Republic of Macedonia. There were 100 healthy subjects (47 men and 53 women), 41 left and 59 right hands. The mean age of the subjects was 42 years±12.42 (range 20 to 60 years). Measurements were made of the third metacarpal, the carpal height, the length of the capitate and the carpal- ulnar distance. The indices, expressed as ratios, included the carpal height ratios (we used two methods--CHR by Youm and Revised CHR as described by Natrass) and the Carpal-Ulnar Distance Ratio. The results we obtained are similar to those we find in the literature (CHR--0.53±0.01; RCHR--1.56±0.02; Carpal-Ulnar Distance Ratio--0.30±0.01). This study shows that these methods are reproducible and the values represent normal reference values that can be used in further kinematic studies of the wrist in our population. Also, these measurements can be used in determining the degree of kinematic dysfunction present in people with wrist abnormalities, and in evaluation of the kinematic effectiveness of real and hypothetical treatment modalities, thus making them exceptionally valuable for the orthopaedic surgeons.

Hip reduction in cerebral palsy with soft tissue operative procedures.

Hip reduction in cerebral palsy patients with a soft tissue procedure was analysed during operative procedure. Eleven patients with unilateral dislocation of the hip and a quadriplegic form of cerebral palsy underwent soft tissue operation on the hips. Tenotomy of the adductor and flexor muscles of the hip was performed. The contralateral hip sustained only tenotomy of the adductor muscles. The average age of the patient study group was 8.5 and the follow-up period was 4 years. In all patients, repositionings of the hip were achieved and stabilization was maintained postoperatively at the regular outpatient follow-up. The range of extension and abduction motion were increased postoperatively compared to the preoperative range of motion. Retention of the hip was maintained within 20 degrees of abduction. Tenotomy of the adductor and flexor muscles enables hip reduction without opening the joint capsule in quadriplegic cerebral palsy patients. The hip became painless and the improvement in the hygiene was evident.

Soft tissue surgical procedures in the prevention of hip dislocation in patients with spastic cerebral palsy.

Hip dislocation in the spastic form of cerebral palsy is mainly unilateral, leading to pelvic deformities, appearance of scoliosis, difficult positioning when seated, as well as pain experienced during walking and standing. Tenotomies of adductor muscles were performed in 22 patients (44 hips), 14 male and 8 female. In 12 patients decrease in migration percentage was noted, the average patient age being 5,4 years. In 10 patients no changes in migration percentage were detected, compared to preoperative values. Mean age of the latter group was 7,2 years. The results of the operative procedures were considered good, since the regular follow-up radiographies (done every 6 months) showed decrease in migration percentage. Adductor muscle tenotomies should be performed in incipient hip dislocations with migration index not overcoming 30%, preferably at younger age.

[New diagnostic potentials in hip dysplasia using sonography]. / Novye vozmozhnosti diagnostiki displazii tazobedrennogo sustava s pomoshch'iu sonografii.

After the completing of the equipment (Squibb medical ultramark 4) with a 5 MNz linear probe and 7.5 sector scanhead and gaining the necessary education by Graf and experience ultrasound is used for the examination. Our work is based on the experience by Graf and Schüler and follow the scheme proposed by the authors. This kind of examination has a great popularity. Based on 4600 ultrasound studies of infantile hips Graf's classification and diagnostic criteria are renewed with regard to their ability to discriminate between normal and pathological conditions.