OUTCOMES OF SURGICAL TREATMENT FOR DISPLACED BOTH-COLUMN ACETABULAR FRACTURES.

Complex both-column acetabulum fractures are severe injuries, often with associated injuries and complications with uncertain clinical and functional outcome. Modern traumatological protocols point to early surgical treatment, with anatomical reduction and stable internal fixation of fragments as a prerequisite for achieving a good treatment outcome. This retrospective-prospective multicenter cohort study was conducted during the 2014-2020 period and included 24 cases that met the input parameters, using the Letournel and Judet classification, and application of a combined surgical approach, a modified Stoppa and Kocher-Langenbeck approach. The results of treatment with complications, associated injuries and functional outcome are described. Fractures were caused by high kinetic energy trauma, and the cause was traffic accident in 17/24 (70.84%), fall from a height in 5/24 (20.83%) and crash injuries in 2/24 (8.33%) cases. The sample included 18 (75.00%) male and 6 (25.00%) female, with 10/24 (41.67%) right sided and 14/24 (58.33%) left sided fractures. Their mean age was 45.06 (range, 24-62) years. The mean follow-up time was 2.8 (range, 1-5) years. Postoperative complications were detected in 14/24 (58.33%) cases, including wound infection in 4/24 (16.67%), deep vein thrombosis in 2/24 (8.33%), heterotopic ossification in 2/24 (8.33%), hip osteoarthrosis in 3/24 (12.50%), avascular necrosis of femoral head in 2/24 (8.33%), total hip arthroplasty procedures in 3/24 (12.50%), abdominal complications in 2/24 (8.33%), urologic complications in 2/24 (8.33%), iatrogenic nerve lesion in 3/24 (12.50%), and fatal pulmonary embolism in 2/24 (8.33%) cases; there was no loss of reduction or non-union acetabular fracture. Associated injuries that we recorded as major trauma were presented in 13/24 (54.17%) study patients. The final functional results according to the Harris Hip Score (HHS) were excellent in 7/22 (31.82%), good in 10/22 (45.45%), moderate in 4/22 (18.18%) patients, and poor in 1/22 (4.55%) patient. The mean HHS was 84 (range 34-98). Complications and results have led us to a conclusion that primary injuries significantly affect the clinical and functional results. A good diagnostic procedure, assessment of the general condition and application of the trauma scoring system, surgical treatment that includes early hip reduction, open reduction internal fixation and physical rehabilitation are necessary.

Measurement of Air Pollution Parameters in Montenegro Using the Ecomar System.

Particulate matter air pollution is one of the most dangerous pollutants nowadays and an indirect cause of numerous diseases. A number of these consequences could possibly be avoided if the right information about air pollution were available at a large number of locations, especially in urban areas. Unfortunately, this is not the case today. In the whole of Europe, there are just approximately 3000 automated measuring stations for PM10, and only about 1400 stations equipped for PM2.5 measurement. In order to improve this issue and provide availability of real-time data about air pollution, different low-cost sensor-based solutions are being considered both on-field and in laboratory research. In this paper, we will present the results of PM particle monitoring using a self-developed Ecomar system. Measurements are performed in two cities in Montenegro, at seven different locations during several periods. In total, three Ecomar systems were used during 1107 days of on-field measurements. Measurements performed at two locations near official automated measuring stations during 610 days justified that the Ecomar system performance is satisfying in terms of reliability and measurement precision (NRMSE 0.33 for PM10 and 0.44 for PM2.5) and very high in terms of data validity and operating stability (Ecomar 94.13%-AMS 95.63%). Additionally, five distant urban/rural locations with different traffic, green areas, and nearby industrial objects were utilized to highlight the need for more dense spatial distributions of measuring locations. To our knowledge, this is the most extensive study of low-cost sensor-based air quality measurement systems in terms of the duration of the on-field tests in the Balkan region.

Bilateral Subcapital Femoral Neck Fracture in a 28 Year Old Postpartum Woman.

INTRODUCTION: Subcapital femoral neck fractures are associated with high morbidity and mortality. These fractures mostly occur as a result of a high-force impact from traffic accidents and a fall from a great height, though non-traumatic forms are described in transient osteoporosis during the second half of pregnancy, in convulsions during electric shock, eclampsia, hypocalcemia, osteomalacia, renal osteodystrophy and myeloma. CASE REPORT: In this report we present a bilateral subcapital femoral neck fracture in a woman sustained two days after delivery. The right hip fracture was treated with fixation using three spongious screws without capsular decompression, while for the left hip a capsular decompression by open reduction and fixation was performed. Physical treatment based on active and passive movements was immediately initiated. The patient was able to rest upon her right leg within seven and upon the left leg within eight months. X-Rays showed the accurate position of fragments and implants throughout the recovery period. Twelve years later, the patient made a full recovery and the x-rays showed that both femoral heads are vital and fully recovered. CONCLUSION: Early anatomical reconstruction followed by internal fixation is crucial in the prevention of long-term complications. Complications of internal fixations include non-union (10-30%), avascular necrosis (15-33%), deep vein thrombosis and pulmonary embolism.

Treatment of Periprosthetic Femoral Fractures after Total Hip Arthroplasty Vancouver Type B.

The rate of periprosthetic femoral fractures following total hip replacement has been growing steadily in the last 20 years and ranges from 0.1% to 2.1%. These fractures are mostly related to older patients with the presence of chronic diseases and frequently poor bone quality. The treatment is surgically very complex and demanding, followed by a series of complications. The evaluation in this retrospective study included 23 patients who were medically treated from January 2004 to December 2015 with the mean follow-up of 14.5 (range, 9-25) months. There were 17 patients with cement total hip arthroplasty (THA) and 6 with cementless THA. During treatment of fractures, different techniques were implemented including the use of wire cerclage, dynamic compression plates (DCP), a locking compression plate (LCP) system, and long revision stem. For the purpose of distinguishing fractures, we used the Vancouver classification by Duncan and Masri. For clinical evaluation, we used the modified Merle d'Aubigne score system and monitored complications during treatment. The aim is to show treatment results of the type B periprosthetic femoral fractures by using different operative treatment techniques. According to the Vancouver classification within type B, 10 (43.47%) patients had type B1 fractures, another 10 (43.47%) patients had type B2 fractures, and three (13.04%) patients had type B3 fractures. According to gender distribution, there were eight (34.8%) male and 15 (65.2%) female patients, mean age 59.5 (range, 47-86) years. Twelve (52.2%) and 11 (47.8%) patients had left- and right-sided fractures, respectively. The mean length of hospital stay was 16 (range, 9-26) days. According to the Merle d'Aubigne score system, 10 patients with type B1 fractures had the mean score of 11.5 points, which is poor result. Poor result was also recorded in patients with type B2 fractures, with the mean score of 10.6 points. The three patients with type B3 fractures had the mean score of 12 points, which is considered fair score. In conclusion, Vancouver classification has been widely accepted and using the protocols makes decision making during treatment much easier. During treatment of this type of fracture, we used various implants, wire cerclage, DCP and LCP, as well as long stem revision. In certain cases, we applied surgical techniques, implants that are not recommended by the Vancouver protocol by which we treated periprosthetic femoral fractures; in these case, we recorded nonunion bone, malunion and breaking of implants, which resulted in poor treatment outcome.

HUMERAL NAIL: COMPARISON OF THE ANTEGRADE AND RETROGRADE APPLICATION.

Application of humeral nail in the treatment of humeral shaft fractures is a relatively novel method of fracture fixation. Its application at Clinical Department of Traumatology, Sestre milosrdnice University Hospital Center began in 2001. The operative procedure should be performed using a minimally invasive technique without fracture opening in order to maintain optimal conditions for fracture healing including hematoma management. However, in everyday practice it is often impossible to obtain satisfactory fracture reduction using the closed procedure, so open reduction and additional fixation with wires or screws are mandatory. Over the last 14 years, fixation of fractures with the locking nail was performed in more than 400 patients. Cases of pseudarthrosis and pathological fractures were also managed successfully. There were more female patients. The mean time from injury to surgery was 2.4 days. Surgery was performed immediately upon admission to the emergency service whenever possible. This study comprised 234 patients with humeral shaft fractures treated with the humeral nail (antegrade insertion was applied in 103 and retrograde in 131 patients). The aim of the study was to stress out the complexity of appropriate operative treatment of humeral shaft fractures using intramedullary fixation, as well as the importance of proper reduction and stable fixation.

TREATMENT OF MEDIAL MENISCUS INJURY WITH PARTIAL MENISCECTOMY.

Partial meniscectomy involves partial removal of the meniscus. This can vary from minor trimming of the damaged part of the meniscus to the removal of the rip from the meniscocapsular junction. Meniscus tears are the most common knee injury. They may occur in acute knee injuries in younger patients, or as part of a degenerative process in older individuals. The aim of the study was to demonstrate the method of choice for treatment of medial meniscus injuries that, in well selected cases, resulted in a small rate of complications and fast rehabilitation. The study analyzed the results of arthroscopic partial medial meniscectomy in 99 patients, in the period from 2005 to 2013, with follow up of 12-14 months. In our series of arthroscopically treated medial meniscus, tears were found in 29 patients with vertical complete bucket handle lesions, 14 with vertical incomplete lesions, 9 with longitudinal tears, 13 with oblique tears, 11 with complex, flap and degenerative lesions, 10 with radial lesions and 13 with horizontal lesions. The mean preoperative International Knee Documentation Committee score was 52.52%, then 81.81% at one month and 92.92% at six months of arthroscopic partial medial meniscectomy. Arthroscopic partial medial meniscectomy is a minimally invasive diagnostic and therapeutic procedure. This procedure is an acceptable and effective long-term treatment, particularly in patients without significant articular cartilage damage, and is associated with minimal morbidity.

Cystic Adventitial Disease in Former Athlete.

In this paper we present a 39-year old former athlete complaining with pain in his legs during long walk resembling to intermittent claudication. Color duplex scan described a popliteal artery with 10 mm in diameter with mural thrombus that caused stenosis 75% of lumen. Digital subtraction angiography demonstrated a stenosis of right popliteal artery. The suspicion for Cystic adventitial disease was set. The patient was operated on by posterior direct approach. After incision, a yellowish viscous material was observed in adventitia. Partial resection of the affected popliteal artery and replacement by an autogenous great saphenous vein graft was performed. Patient was dismissed on the seventh postoperative day, in good condition and without any complication. Cystic adventitial disease of the popliteal artery should be considered in the differential diagnosis of intermittent claudication, especially in former sportsmen patients. Partial resection of the affected popliteal artery and replacement by an autogenous great saphenous vain graft produces excellent results.

[Operative vs. non-operative treatment of acute Achilles tendon rupture].

INTRODUCTION: It affects most frequently middle aged recreational male sportsmen (30-50 years old), previously followed by prodromal symptoms (5-33%). Rupture spot is 3 to 5 cm above heel bone vertex (90-95%) Retrospective study. WORKING OBJECTIVE: Comparison of functional re-. suits and complications of cast immobilization non-operative treatment and open suture surgical treatment. MATERIAL AND METHODS: Overall 46 patients included who were treated at the Clinic for Orthopedics and Traumatology within the Clinical Center of Montenegro in Podgorica between 2004 and 2012. Patients were divided into two groups: I group consisted of 21 patients (45.65%) who were treated by cast immobilization and the II (control) group consisted of 25 patients (54.35%) who were treated by open surgical technique. Division by gender: 44 male patients (95.65%) and 2 female patients (4.35%). WORKING RESULTS: The average age of patients was 38.8 +/- 2.79 (21-60 years of age); for the patients treated operationally 37.1 +/- 3.98 years of age, for the patients treated non-operationally 40.2 +/- 2.39; 28 right side patients (60.86%), 18 left side patients (39.14%); Surface infection detected on 1 patient (2.17%); 2 patients with partial rupture, while 3 patients had complete rupture during early rehabilitation period after immobilization was taken off. Complete rupture detected on 3 patients (6.25%) has been recovered surgically. Thromboembolism noticed on 3 patients (6.52%) while 2 patients (4.34%) were affected by pulmonary embolism. Tendon elongation present on 3 patients (Magnetic Resonance (MR) Diagnostics) and on 1 patient reoperation was performed 3 months after the primary surgical intervention. CONCLUSION: This study didn't show significant statistical difference between two ways of treatment, but early immobilization is recommended because of better results. In case of Achilles tendon rupture, the advantage should be given to the surgical treatment, especially if younger population is treated.