Medical thermography (digital infrared thermal imaging - DITI) in paediatric forearm fractures - A pilot study.

Trauma is the most common cause of hospitalisation in children, and forearm fractures comprise 35% of all paediatric fractures. One-third of forearm fractures are distal forearm fractures, which are the most common fractures in the paediatric population. This type of fracture represents an everyday problem for the paediatric surgeon. The three phases of fracture healing in paediatric trauma are associated with skin temperature changes that can be measured and then compared with standard plain radiographs of visible callus formation, and eventually these methods can be used in everyday practice. Thermographic assessment of temperature distribution within the examined tissues enables a quick, non-contact, non-invasive measurement of their temperature. Medical thermography is used as a screening method in other parts of medicine, but the use of this method in traumatology has still not been researched.

[Analysis of results of surgical treatment of malleolar fractures]. / Analiza kasnih rezultata kirurskog lijecenja maleolarnih prijeloma.

Late results of operatively treated malleolar fractures were analyzed. 101 patients were operated on, 58 (57.4%) were available for follow-up. There were 5 patients with A-type fractures according to Weber's classification, 28 with type-B and 25 with type-C fractures. One year or more after the treatment the patients were evaluated on follow-up checks where ranges of ankle dorsiflexion, plantar extension, pronation and supination were recorded, circumference of the injured ankle was measured and the patients were interviewed about subjective complaints. Normal range of motion of the injured ankle (normal range of motion represented by the healthy ankle) was found only in patients with type-A fractures while in other two groups the patients had significantly decreased motility of the injured ankle (P < 0.05). The circumference of the injured ankle was increased in most patients with 25.9% patients ankles being 20 mm or more thicker than the uninjured side. Only seven patients (12.1%) were without subjective complaints while other patients experienced pain with load, pain with weather changes, swelling of the ankle etc. Malleolar fractures still represent a significant surgical problem and only an early operation, anatomic reduction and fixation as well as proper rehabilitation guarantee good results.

[Treatment of pseudarthroses of the olecranon with the anatomical hook plate]. / Lijecenje pseudartroze olekranona anatomskom kukastom plocicom.

We report the results in seven patients treated surgically for nonunion of the olecranon. Four nonunions occurred after primary treatment with tension band wiring and three nonunions occurred after open reduction internal fixation with plates and screws or lag screws only. All patients were treated with cancellous bone grafting and open reduction internal fixation using anatomical hook plates. All nonunions united within 6 months after the treatment. In all patients the range of motion of the elbow improved significantly.

[Posterior sagittal anorectoplasty (PSARP) in children with high anal atresia]. / Posteriorna sagitalna anorektoplastika (PSARP) u djece s visokom atrezijom rektuma.

Anorectal anomalies are highly significant (the incidence of 1:3000 infants). The knowledge of the factors related to fecal continence encouraged the introduction of new surgical approaches in the second half of this century. With high supralevator anorectal anomalies the percentage of incontinence in children was earlier 50-80% although in all surgical procedures efforts were made to reconstruct the normal anatomy of the small pelvis. It was only in 1982 that by the PSARP method the anatomic reconstruction was achieved. In this operation an electric stimulator is used to identify the entire muscle-sphincter complex (external sphincter, the cross-striated muscle complex and the levator musculature) and then by stimulation of muscles a mobilized and modeled rectum is inserted into the muscle-sphincter complex. During the ten-year application of the PSARP method 15 children underwent the operation, of which 14 boys and 1 girl. The girl had rectovaginal fistula and 11 boys had rectourethral fistula. More than 70% of our children showed accompanying anomalies. Control examinations of children older than 3 years show the 67% continence in our children operated by the Pena-de Vries method.

[Laparoscopic cholecystectomy in a child with sickle cell disease]. / Laparoskopska kolecistektomija u djecaka s drepanocitozom.

Laparoscopic cholecystectomy has become the procedure of choice for the removal of the diseased gallbladder in children. Its use in small children and infants is rare. At the Department of Pediatric Surgery of the Medical faculty in Zagreb five children underwent laparoscopic cholecystectomy. One of them was a five year old boy with sickle cell disease and cholelithiasis. Before the advent of laparoscopy, few children with sickle cell disease and cholelithiasis underwent cholecystectomy, because of the high morbidity associated with open cholecystectomy. The authors use the case to present details of the operative procedure of laparoscopic cholecystectomy in small children and infants. Laparoscopic cholecystectomy is the procedure of choice in the management of cholelithiasis in small children and infants, especially those with sickle cell disease.

Urolithiasis in childhood: surgery and lithotripsy.

From 1982 through 1993, 174 interventions in 160 infants and children with urolithiasis were performed at our department. There were 101 boys and 59 girls, mean age 8.9 years. The main causes of the interventions were congenital malformations in 62, followed by recurrent urinary tract infections in 29, previous operations in 17, and hypercalciuria in 35 patients. In 17 children, the cause of urolithiasis remained unknown. As a therapeutic option, extracorporeal shock-wave lithotripsy (ESWL) has become available since 1988. The malformations and postoperative conditions are surgically corrected, and the calculi removed in the same act. For post-infectious, idiopathic or hypercalciuric calculi, ESWL has been used in the majority of patients since 1988. Thus, a total of 129 calculi were removed by operation and 47 by ESWL, whereas 18 calculi were endoscopically extracted. There were no complications after either ESWL or open surgery. Calculi in congenital malformations or as a result of operation are still removed by open surgery. In other cases, ESWL is the method of choice.