[Show abstract][Hide abstract] ABSTRACT: Background:
Femoral neck fractures in children are very rare and account for about 1% of all paediatric fractures. The aim of this retrospective study was to analyse the clinical and radiographic outcome in paediatric femoral neck fracture and to review the role of early decompression of the hip in the final outcome.
Patients and methods:
The study was performed at the Department of Paediatric Orthopaedics and Traumatology, University Children's Hospital in Belgrade, Serbia from January 1996 to January 2010. The study included 28 patients, 12 female and 16 male, aged 4-14 years. Patients who were aged over 14 years or who had pathological femoral neck fractures or metabolic disturbances were excluded from the study. The type of neck fracture was determined according to the Delbet and Colonna classification. The patients were treated using different surgical procedures: closed reduction and cast immobilisation, closed reduction and percutaneous fixation with Kirschner wires (K-wires), closed reduction and fixation with cannulated screws and open reduction with Wagner plate stabilisation. The final outcome was evaluated using the clinical outcome (based on the Howorth-Ferguson scale), radiographic outcome and occurrence of complications.
The median age of patients included in the study was 10.75 years and the average follow up was 9 years. According to the Delbet classification, there was one patient with type I, eight patients with type II, 16 patients with type III and three patients with type IV femoral neck fracture. Based on the Colonna classification, there were 23 displaced and five non-displaced femoral neck fractures. Decompression of the hip was performed in 21 patients. Avascular necrosis (AVN) developed as the main complication in 11 patients. The final outcome was excellent in 14 patients, good in four patients and poor in 14 patients.
Our study unequivocally confirms the positive effect of urgent treatment on the incidence of AVN as well as on the outcome. We have established a 12-hour interval after injury as an optimal time limit for commencing treatment. Unambiguously positive effects of hip decompression on the incidence of AVN were also noted. We found similar efficiency for open and needle hip decompression.
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to evaluate the influence of intramedullary (IM) alignment used in combination with an Ilizarov external fixation on the healing index (HI) and lengthening index (LI) in the treatment of congenital leg length discrepancies (LLD). This study included 35patients aged from 3.5 to 19 (average age 10.73) who underwent thl egalisation procedure using an Ilizarov external fixator. We compared the duration of the external fixator application, LLD, HI and LI between two groups of children: children in Group I underwent limb lengthening by the conventional llizarov technique using an Ilizarov external fixator alone, and children in Group II underwent a combination of Ilizarov technique and intramedullary alignment with two Kirschner wires, introduced through two mini-incisions. We found significant differences between the two groups of patients for duration of external fixator application and HI. Patients with congeni- tal LLD treated with combined method of treatment had benefit from intramedullary alignment due to its better outcome.
No preview · Article · Dec 2014 · Collegium antropologicum
[Show abstract][Hide abstract] ABSTRACT: The use of radical surgical treatments in treating congenital clubfoot is decreasing. Minimally invasive surgical treatment (MIST) is a way of treating congenital clubfoot, which is a kind of compromise between a radical surgical treatment and non-operational one. A few protocols of different authors McKay, Macnicol, Stevens, Meyer, G.W.Simons and Laaveg-Ponseti were used in the evaluation of the results. SCIENTIFIC OBJECTIVE: To determine the importance and role of groups of parameters (clinical, radiographic and functional) in the evaluation of the results in patients treated with the two methods (radical operation and MIST).
This paper covers children who were treated for structural (idiopathic) form of PEVC. The testing is a prospective study and was conducted in two groups of patients. Group A (radical surgical treatment) - control group, where the total number of subjects was 50, out of which 35 male (70%) and 15 female (30%). The number of feet tested was 88. Group B (minimally invasive surgical treatment-MIST)-experimental group. The total number of subjects was 48, out of which 35 male (73%) and 13 female (27%). The number of feet tested was 84. For the analysis of the results, we used a questionnaire. The total number of parameters was fifteen, clinical, radiographic and functional, five parameters of each. Normal findings or measured value was determined by 0 points. The range of the total score (TS-a- total score range) 0-27 points, and the results were sorted out into the folowing categories: good result (0-5) satisfactory (6-11), poor (12-19) and deformity recrudescence (20-27) points.
The proportion of good results at 88 feet in group A was 0,477 as at 84 feet in group B it was significantly higher and came to 0,893. The difference between these proportions is statistically highly significant (t = 5.84, p <0.001). Chi-square test (χ2 = 30.083 df = 1 N = 172, p <0.001) indicated that there is a highly significant correlation between the method of treatment used and results of treatment. Good results of treatment in group A were observed in 48% and in group B in 88% of cases. The Charles Spearman nonparametric method showed that the rank correlation coefficients for the group A are positive, quite high (between 0.70 and 0.85), similar and statistically highly significant (p <0.001). The influence of radiographic scores on the total score is the lowest, and clinical score on the overall score is the highest. Rank correlation coefficients for group B were also positive but somewhat smaller than in group A (between 0.55 and 0.75) and statistically highly significant (p <0.001). It is possible to notice the difference here and say that the impact of functional scores on the total score is the highest and of radiographic score the lowest.
Minimally invasive surgical treatment (MIST) gives better functional results in the treatment of congenital clubfoot than radical surgical treatment. The role of radigraphic parameters in the evaluation of the results of the treatment was the slightest regardless of whether the treatment was radical surgery or MIST. We believe that radiography for routine analysis of the results of treatment need not be used.
[Show abstract][Hide abstract] ABSTRACT: Introduction
T-condylar fractures of the humerus are very rare in children. The treatment options vary from simple reduction and percutaneous stabilization to open reduction and fixation with plates, screws and Kirchner wires. We evaluated 19 patients who underwent different types of treatment aiming to compare two different approaches of reduction, postoperative results and complications.
The study encompassed total of 19 patients with T-condylar fracture, aged from 3 to 16 years, who underwent either closed or opened reduction between February 2005 and September 2012. Closed reductions were performed in 7, and open reductions in 12 patients. Results were analyzed using the Orthopaedic Trauma Association scoring system with 6 domains (range of motion, anatomic restitution, return to activity level, pain, subjective feeling and disability). Results were measured on a 4-point scale (1-excellant, 2- good, 3-fair and 4-poor).
The mean follow-up was 49 months (range from 12-97 months). According to the type of fracture, excellent results were achieved in 10, good in 8 and poor in one patient. According to method of treatment, an excellent outcome was noted in 6 and 4 patients, following closed and opened reduction, respectively. No statistical analysis was performed because of the small sample size.
The present study concludes that any type of T-condylar fracture of the humerus can be solved to a satisfactory degree, either closed or open reduction and with proper stabilization.
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to evaluate the influence of intramedullary (IM) alignment used in combination with external fixation on the healing index (HI) and lengthening index (LI) in the treatment of congenital and acquired leg length discrepancies (LLD). We compared duration of the external fixator application, LLD, HI and LI between two groups of children: children in Group I underwent limb lengthening by the conventional llizarov technique, and children in Group II underwent a combination of Ilizarov technique and intramedullary alignment with Kirschner wires. Two types of LLDs were treated: congenital and acquired. We found significant differences between the two groups for duration of external fixator application and HI. Significant differences were also noted in the duration of the external fixator application, HI and LI, between patients with congenital and acquired LLDs. We also noted significant differences between Group I and Group II regarding duration of external fixator application for patients with congenital LLD and also regarding HI for both congenital and acquired types of LLD.
No preview · Article · Aug 2013 · Acta orthopaedica Belgica
[Show abstract][Hide abstract] ABSTRACT: The study aim was to evaluate inflammation markers values (C-reactive protein (CRP), Erythrocite sedimentation (ES), White blood cells count (WBC)) in surgically treated pediatric patients with diagnosed developmental displasia of the hip or Perthes disease before and after operation.
We have evaluated 43 children (20 patients were with diagnosed unilateral developmental displasia of the hip while 23 had Perthes disease). Blood samples were drown at the admission and 5 days after admission, and further inflammatory parameters were analyzed: ES (mm/hour), CRP (mg/L) and WBC (x1000/mm3) count.
Elevated erythrocite sedimentation (ESR) was significantly frequent than elevated CRP (p<0.01) and elevated WBC as well (p<0.01). Values of ESR and WBC do not correlate closely with age (FESR= 1.805; FWBC= 0.130; p>0.05) while CRP values correlate significantly with the age of the patients (FCRP= 4.948; p<0.05). The most frequently isolated marker was ESR (34.88%). The most frequent elevated two markers were ESR and CRP (44.19%).
Surgical procedure could alter the values of inflammatory markers leading to the increasement even though there is no other clinical signs of infection. For estimation of the possible presence of the infection, clinical signs and patients intensive clinical follow-up after the surgery, should be done along with the evaluation of inflammatory markers. KEY WORDS: Children, Inflammatory markers, Surgery.
No preview · Article · Feb 2013 · Annali italiani di chirurgia
[Show abstract][Hide abstract] ABSTRACT: We assessed the quality of life of children with developmental dysplasia of the hip (DDH) treated surgically, through analysis of leg length discrepancy, quality of walking and presence of pain in 39 children with DDH between 1991 and 2011 at the University Children's Hospital in Belgrade. Salter's innominate osteotomy combined with derotation and femoral bone shortening was performed. Patients were divided into 3 groups based on their age at operation: the first group included participants operated at age up to 24 months, the second group between 24 and 48 months and the third group above 48 months of life. In the first group, leg length discrepancy was present in 30.76% and mean leg shortening was 0.63cm, versus 27.77% and 1.30 cm in the second group and 37.50% and 1.50 cm in the third group. Children with DDH that were operated earlier in life had less leg shortening and did not display any significant asymmetry of walking.
No preview · Article · Feb 2013 · Acta orthopaedica Belgica
[Show abstract][Hide abstract] ABSTRACT: Obesity is a complex condition with multifactorial origin. Assuming that such a state is genetically controlled, the aim of our study was to evaluate the degree of genetic homozygosity among overweight and obese individuals by the homozygously recessive characteristics (HRC) test.
We analysed the presence, distribution and individual combination of 15 selected genetically controlled recessive phenotype traits in a sample of 140 individuals with increased body mass index (overweight individuals n = 100 and obese individuals n = 40) and a control group of normal weight individuals (n = 300).
OBESE INDIVIDUALS HAVE SIGNIFICANTLY HIGHER MEAN VALUES FOR GENETIC HOMOZYGOSITY THAN THOSE WITH NORMAL WEIGHT (NORMAL WEIGHT: 3.61 ±1.48; obese: 4.13 ±1.47, p < 0.05) and difference in the presence of certain individual combinations of evaluated phenotype traits (Σχ(2) = 76.9; p < 0.01). There was no difference in average homozygosity of such genetic markers between groups of normal weight and overweight individuals (normal weight: 3.61 ±1.48; overweight: 3.93 ±1.51, p > 0.05) and between groups of overweight and obese individuals (overweight: 3.93 ±1.51; obese: 4.13 ±1.47, p > 0.05). There is no difference in the presence of certain individual combinations of evaluated phenotype traits between overweight and obese individuals (Σχ(2) = 20.6; p > 0.05).
There is a populational genetic difference in the degree of genetic homozygosity and variability between the group of normal weight and group of obese individuals, indicating a possible genetic component. Overweight and obese individuals have a genetic predisposition, but different expression of genetic loads could be one of the possible explanations for different susceptibility to increase of fat mass and body mass index.
Full-text · Article · Dec 2012 · Archives of Medical Science
[Show abstract][Hide abstract] ABSTRACT: Aim of our study was to evaluate distribution of ABO and Rh blood type groups in children after hip surgery regarding transfusion administration and fever presence.
Four types of ABO blood groups (A; B; AB; O) and 2 types of Rh blood groups (Rh+; Rh-) were evaluated in group with administered transfusion (tr+) and without given transfusion (tr-); and in group with fever (fev+) and without fever (fev-), in 146 children after hip surgery. Tr+ and fev+ groups were divided into 3 groups (0-24h; 25-48h; 49-72h): for tr+ group (Group 1, Group 2, Group 3), and for fev+ group (Group A, Group B, Group C).
AB blood group significantly decreased in Group 1 (χ2= 6.44; p<0.05) and A blood group in Group 3 in tr+ group (χ2= 7.68; p<0.01). O blood group significantly increased in Group 3 in tr+ group (χ2= 9.96; p<0.01). AB blood group significantly decreased in Groups B (χ2= 12.2; p<0.01) and C (χ2= 4.2; p<0.05) in fev+ versus fevgroup. B blood group significantly increased in Group C (χ2= 34.4; p<0.01) in fev+group.
Administration of transfusion and fever onset in pediatric patients undergoing surgical correction of the hip is not influenced by the ABO and Rh blood groups system in humans. There is correlation between distribution of ABO blood groups with the time of transfusion administration and fever onset in children after hip surgery.
No preview · Article · Oct 2012 · Annali italiani di chirurgia
[Show abstract][Hide abstract] ABSTRACT: Background:
Aim of our study was to evaluate degree of genetic homozygosity in male and female gender of spina bifida (SB) occulta and SB aperta patients.
Patients and methods:
We evaluated 95 patients with SB occulta and 51 with SB aperta. Degree of genetic homozygosity was evaluated by direct observation of 15 homozygously recessive characteristics (HRC) by HRC-test separately for SB occulta and SB aperta participants. Additionally 370 individuals without SB from Serbia were randomly selected and evaluated as control group. Male and female gender was separately evaluated for assessing degree of genetic homozygosity.
There was no significant difference in mean values of HRC between male and female gender in control group (male gender -3.9±1.2, female gender -4.0±1.4, z=0.39; p>0.05), SB occulta (male gender -4.1±1.5, female gender -4.7±1.4, z=1.87, p>0.05) and SB aperta patients (male gender -4.3±1.6, female gender -4.5±1.4, z=0.66, p>0.05), while there was significantly increased recessive homozygosity in female SB occulta group versus control female group (Females: SB occulta -4.7±1.4, Control group -4.0±1.4, z=3.16, p<0.01) and female SB aperta group versus control female group (Females: SB aperta -4.5±1.4, Control group -4.0±1.4, z=2.05, p<0.05).
There is increased recessive homozygosity in tested female SB occulta and female SB aperta individuals versus SB male participants and significantly increased recessive homozygosity in female groups of SB patients versus control female group. These findings could lead to the possible assumption that different genes in different degree might be expressed in SB occulta and SB aperta patients.
[Show abstract][Hide abstract] ABSTRACT: Patients with spina bifida in the lumbosacral region usually have various degrees of motor and sensory dysfunctions of the lower extremities and anal sphincter. The aim of our study was to evaluate the distribution and differences in frequencies of affected muscles, number of affected muscles and degree of neurogenic lesion between patients with spina bifida occulta (SBO) and spina bifida aperta (SBA).
In 100 patients with SB, 6 muscles in the lower limbs were separately analysed. Due to the number of affected muscles, we evaluated 5 groups of patients: with 1 affected muscle, 2 affected muscles, 3 affected muscles, 4 affected muscles and 5 affected muscles. Three degrees of neurogenic lesions were assessed: mild, moderate and severe.
The tibialis anterior muscle was most frequently affected in SB patients. The outer anal sphincter was frequently affected in the group of SBA patients. Single muscle affection is frequent in the group of patients with SBO, while in the group of patients with SBA, 4 muscles were significantly frequently affected. The great majority of patients (45.46%) with affected outer anal sphincter (OAS) in the group of SBO were without affection of other muscles, while for the SBA group it was for every third patient. Mild neurogenic lesion was significantly frequent in SBO patients, while severe form was significantly frequent in SBA patients.
Patients with SBO usually present with mild to moderate clinical presentation, while multiple root involvement and severe degree of neurogenic lesion is associated more frequently with SBA.
Preview · Article · Dec 2011 · Archives of Medical Science
[Show abstract][Hide abstract] ABSTRACT: We report two infants with celiac crisis who continued to have persistent secretory diarrhea despite gluten and lactose free diet and supportive parenteral nutrition. The children were given corticosteroid therapy. After a five-day oral prednisone in the dose of 2 mg/kg/daily, both patients rapidly recovered.
Full-text · Article · Aug 2011 · Indian pediatrics
[Show abstract][Hide abstract] ABSTRACT: Aim of the study was to analyze age structure of the patients with developmental dysplasia of the hip (DDH) at the time of the operation and epidemiological determinants: gender distribution, proportion of left or right hip affection, type of delivery and mode of labor presentation.
The population of 78 children with DDH was evaluated. Three age groups were analyzed: first group younger than 24 months of life, second group between 24 and 48 months and third group older than 48 months of life. Male and female gender was separately evaluated as well as type of delivery and mode of labor presentation. Separately, 2 groups regarding affected hip were analyzed: group with affected left hip and group with affected right hip. Radiographic findings (Collodiaphyseal angle, Hilgenreiner angle and Wibergs center-edge angle) and clinical findings (positive Trendelenburgs sign, reduced flexion angle (<114°), pain in the hip and incomplete crouch) were evaluated regarding: age of the patients, gender, mode of presentation and type of delivery.
There was 33.3% of patients in the first age group, 46.2% of patients in second group and 20.5% of patients in third age group, and regarding gender, 17.9% of males and 82.1% of females. Vaginal delivery was predominant mode with distribution of 87.2% as well as head presentation with distribution of 71.8%. Distribution of children with affected left hip was 46.2% and right hip 53.9%.
Majority of patients in the study were in the age group between 24 and 48 months of life, suggesting delay in on-time diagnostics of DDH. Female gender was more frequently affected by DDH and vaginal delivery as well as head presentation of newborn was significantly frequent in patients with DDH. It is shown that Collodiaphyseal, Hilgenreiner and Wibergs center-edge angles values are in correlation with the age structure of the patients with DDH at the time of diagnosis. Male gender tends more frequently to present with clinical findings. Reduced flexion angle of the hip is the frequent clinical finding for children with DDH that were born by breech presentation or delivered by Caesarean section.
Female gender can be taken as one of possible risk factors during clinical examination of newborn regarding diagnostics of DDH, while breech presentation has been shown not to be one of possible risk factors. Early diagnostics and prompt treatment are beneficial in overall outcome for children with DDH. Therefore, there is great need for countinous education of orthopedic surgeons and pediatricians.
Preview · Article · Jun 2011 · Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca
[Show abstract][Hide abstract] ABSTRACT: We compared individual trait variability in 65 male and 81 female patients with spina bifida occulta (SBO) or spina bifida aperta (SBA) against 170 male and 200 female subjects randomly selected Serbian subjects without these conditions. Variability was evaluated by direct observation of 15 homozygous recessive traits (HRT), while gender was evaluated separately. Individual trait variations between genders in SBO patients (4/15 HRT) and in SBA patients (12/15 HRT) showed remarkable differences. Individual trait variations between the male control group and SBO (9/15 HRT), between the female control group and SBO (5/15 HRT), between the male control group and SBA (8/15 HRT), between the female control group and SBA (9/15 HRT), between male SBO and SBA patients (6/15 HRT), between female SBO and SBA patients (6/15 HRT), also indicated remarkable differences. These differences could be explained by different expression of genes that may contribute to expression of spina bifida (SB).
Full-text · Article · Jun 2011 · Balkan Journal of Medical Genetics
[Show abstract][Hide abstract] ABSTRACT: Biliary calculosis is rare in children. It occurs associated with different haemolytic and non-haemolytic disorders, which are sometimes also combined.
A 15-year-old male was hospitalized due to biliary calculosis and non-conjugated hyperbilirubinemia. A mild non-conjugated hyperbilirubinemia, without anaemia and other symptoms of liver dysfunction, was registered at age 8 years, and 7 years later cholelithiasis with transitory choledocholithiasis. The finding of ellyptocytes in blood smear, which was also verified in mother, normal haemoglobin count and the absence of diseases followed by secondary dysmorphic erythrocytes of this type, indicated a clinically milder (compensated) hereditary ellyptocytosis, while more than a double increase of non-conjugated serum bilirubin fracture after a three-day hypocaloric diet (400 kcal per day) showed the concurrent presence of Gilbert's syndrome. In the laparascopically removed gallbladder a larger number of small pigmented calculi were disclosed.
Gilbert's syndrome is an essential precipitating factor of biliary calculosis in patients with chronic haemolytic condition. Thus, in all cases of biliary calculosis and non-conjugated hyperbilirubinemia with absent clinical and laboratory parameters of liver disorders and anaemia, except in compensated haemolytic disease and Gilbert's syndrome as isolated disorders, a possibility of their association should be taken into consideration.
Full-text · Article · May 2011 · Srpski arhiv za celokupno lekarstvo
[Show abstract][Hide abstract] ABSTRACT: Idiopathic ulcerative colitis (IUC) represents a rare disease of childhood. It usually occurs at age over 10 years, and below that exceptionally rarely.
The aim of the paper was to analyze the clinical signs, symptoms and therapeutic procedures in children with IUC.
The aims of the paper were based on a sample of 17 children (11 male and 6 female, mean age 11.90 +/- 3.50 years; range 3.8-17.5 years) with IUC. The disease diagnosis was based on characteristic endoscopic and pathohistological findings.
The basic signs of the disease involved chronic mucosal haemorrhagic diarrhoea which was confirmed in 16 of 17 patients, with body weight deficiency (10), recurrent abdominal pain (6), fever (5), slowed-down maturation (5), marked anorexia (4), and tenesmus (3).Two patients had recurrent aphthous stomatitis, 2 anal fissures, 2 arthralgia, one autoimmune hepatitis and one pyoderma gangrenosum. None of the children had longitudinal growth retardation. Elevated sedimentation rate and C-reactive protein in blood were registered in 11, sideropenia in 10, anaemia in 6 and hypoalbuminemia in 3 patients. The remission of proctosigmoiditis and left-sided colitis was achieved with aminosalicylates, and of pancolitis with the combination of aminosalicylates and glucocorticoids, except in cases of steroid-dependent colitis, which additionally required azathioprine.
The main signs of IUC in children are chronic mucous haemorrhagic diarrhoea, body weight loss and sideropenic anaemia, while the basic therapy consists of aminosalicylates, and in more severe cases of the disease the initial use of glucocorticoids and later azathioprine.
Preview · Article · Mar 2011 · Srpski arhiv za celokupno lekarstvo