[Pelvic discontinuity in revision total hip arthroplasty--case report]. / Zdjelicni diskontinuitet u revizijskoj artroplastici kuka--prikaz bolesnika.

Revision total hip arthroplasty with massive bone loss and pelivic discontinuity has no standardized treatment up until now. This report presents a case of a female patient with a diagnosed pelvic discontinuity 4 years after the previous hip arthroplasty. The patient is suffering from rheumatoid arthritis, and was admitted to hospital treatment for hip pain, leg shortening, limitated range of motion and the inability to walk. Pelvic discontinuity was identified in preoperative radiographs of the pelvic and hip region, and intraoperatively it was determined that it was a type IV b discontinuity according classifications for acetabular defects defined by AAOS, and subclassification of type IV according Berry et al., that is discontinuity associated with cavitary and segmental acetatabular bone loss. In the goal of achieveing a stable construction, as a vital prerequisite for achieving bone consolidation, an osteosynthesis of the posterior column was done with a reconstructive plate by A.O. method, and afterwards the defect was filed with bone transplants from the bone transplant bank. An adequate revision cementless cup was installed, and screws were used to achieve a good fixation of the bigger modeled bone transplants and the fixation of the cup for the remainder of the pelvis. By that method a good inicial stability of construction was achieved. In the goal of achieving bone ingrowth and avoidance of mechanical failure it was advised an avoidance of weight bearing in the period of 3-6 months after the operation. With the method of reconstruction we applied after 2 years of follow-up the cinical result was satisfactory, and radiologicaly there are no signs of construction loosening so it can be claimed that the discontinuity was cured.

[Osteochondral fracture of the patella after acute dislocation]. / Kostano-hrskavicni prijelom ivera kao posljedica akutne luksacije.

Acute patellar dislocation is a common injury in young athletes, which occurs due to inappropriate biomechanical relations and anatomic deviations in the area of knee joint. In these unfavorable conditions, abrupt and vigorous strain of the quadriceps muscle of the thigh may result in lateral patellar dislocation. A case is presented of a young male athlete with acute patellar dislocation and consequential osteochondral fracture. Although x-ray showed normal knee finding, typical history, clinical examination and magnetic resonance image of the knee indicated arthroscopy, which confirmed the diagnosis ofpatellar dislocation. The osteochondral fragment was found and fastened by screws, thus reconstructing the articular surface of the patella. Medial patellar stabilizers were strengthened and lateral stabilizers loosened, thus re-establishing its anatomic slide way. On second-look operation, the screws were removed. In this case, good anatomic and functional outcome was achieved by timely operative treatment, joint surface reconstruction and rehabilitation.

Conservative treatment of extra-articular Colles' type fractures of the distal radius: prospective study.

AIM: To determine the anatomical and functional results of conservative treatment of extra-articular Colles' type fractures of the distal radius and the borderline value of each anatomical parameter for the best possible correlation with functional end result. METHODS: This prospective study included 54 patients. Standard radiographs were made of both wrists in two directions after the fracture, then of the injured side on day 11 following repositioning, and finally of the union of bone segments. Anatomical results were assessed by evaluating the dorsal angulation, loss of radial inclination, and loss of radial length. Functional results were assessed by the evaluation of pain, range of active motion, grip strength, and appearance of the wrist joint. RESULTS: Statistically significant association was found between the anatomical and functional results (chi-square=16.3, p<0.001). Excellent or good anatomical and functional results were obtained in 24 patients, whereas in 30 patients both treatment outcomes were assessed as fair or poor. If < or=10 degrees of dorsal angulation was taken as a borderline value for a good outcome, there was significant association with a good functional result (chi-square=23.6, p<0.001). However, if < or=9 degrees loss of radial inclination was taken as a borderline value for a good outcome, no association with a good functional result was found (chi-square=3.9, p=0.530). If < or=6 mm of radial shortening was taken as a borderline value for a good outcome, again no association existed with a good functional result (chi-square=6.43, p=0.011). CONCLUSION: We found an association between anatomical and functional results after conservative treatment of extra-articular Colles' type fracture of the distal radius. Acceptable borderline dorsal angulation was < or=9 degrees; acceptable loss of radial inclination was < or=3 degrees, and acceptable loss of radial length was < or=2 mm.