Browsing by Author "Jeremić, Danilo (57210977460)"

Introduction The fractures of the posterior process of the talus are relatively rare injuries of the ankle. They most frequently occur via the mechanism of the forced hyper plantar flexion and inversion. Sometimes they are not initially diagnosed, since over 40% of cases of the fractures of the posterior process of the talus are not seen in the initial radiography. The objective of this work is the review of the case study of the arthroscopically treated unhealed fracture of the posterior process of the talus. Case outline In our case report we present a 30-year-old male, professional soccer player, with a threemonth-long history of chronic pain in the region of the left ankle and heel and the fracture of the posterior process of the talus. Conclusion The work shows all the advantages of minimally invasive surgery – arthroscopic excision of the fragment, quick recovery and returning to physical activities. © 2021, Serbia Medical Society. All rights reserved.

Background/Aim. There are a few research papers in Serbia that report on the clinical results of scarf osteotomy (SO) and its long-term effects. The aim of this retrospective study was to evaluate the efficacy of SO in hallux valgus (HV) deformity correction, as well as the degree of recurrence and its possible causes. Methods. The study included 48 patients (52 feet) who underwent SO. The average follow-up time was 103.9 (63–156) months. In order to clinically evaluate the results, the American Orthopedic Foot and Ankle Society (AOFAS) scale and the Visual Analog Scale (VAS) of pain were used. In order to radiographically determine the degree of deformity, preoperative and postoperative radiographs of the feet were taken in the standing position, and the following parameters were determined: HV angle (HVA), intermetatarsal angle, distal metatarsal articular angle, and sesamoid position. Results. The AOFAS scores increased from 19 (5–45) points preoperatively to 92 (54–100) points at the time of the latest follow-up examination (p < 0.001). The VAS values significantly improved from 10 (8–10) preoperatively to 0 (0–6). The average HVA correction was 24.8°. The recurrence rate in patients in whom the HVA was greater than 20° was 26.9%. Conclusion. Although SO is a proven procedure for the correction of HV, long-term results still show a relatively high rate of recurrence. © 2023 Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.

Introduction Positron emission tomography (PET) with computed tomography (CT) using fluorine-18-labeled fluorodeoxyglucose (18F-FDG PET/CT) is a hybrid diagnostic method based on the cell’s glucose uptake detection, which correlates with the degree of disease activity. While other diagnostic procedures fail to evaluate functional tissue,18F-FDG PET/CT can be helpful in discovering active disease in patients with vascular graft infection. Methods This cohort retrospective study included 22 patients (17 male, five female; aged 61.7 ± 16.1) with suspected vascular graft infection. Blood analyses and CT were performed in all patients. Degree of glucose uptake was evaluated visually and semiquantitatively using maximal standardized uptake value (SUVmax). Findings were considered positive if focal fluoro-deoxyglucose (FDG) accumulation was greater in vascular graft projection than other parts of the blood vessel and liver. Results The sighs of active disease were found in 19 patients (86%) (16 male, three female) at the level of implanted vascular grafts: Six aortobifemoral (27%), four aortoiliac (18.2%), four of abdominal aorta (18.2%), two of thoracic aorta (9.1%), two femoral (9.1%), one femoropopliteal (4.5%) (SUVmax 7.9 + 2.4). Two patients were considered true and one false negative- due to antibiotic usage, which reduces FDG uptake. PET/CT helped in treatment alteration of 12 patients, seven (31.8%) started new medicament therapy, five (22.7%) had a surgical graft replacement. Overall sensitivity of this method is 95%, specificity 100%, positive predictive value 100%, negative predictive value 66.6%, accuracy 95.4%. Conclusion18F-FDG PET/CT is a useful diagnostic method in detection of active vascular graft infection with high diagnostic accuracy, which is important in avoiding unnecessary surgery and appropriate therapy planning. © 2019, Serbia Medical Society. All rights reserved.

Introduction Calcaneus fractures are rare but potentially debilitating injuries. Most of them are displaced intraarticular fractures, whose management is among controversial issues. There is no consensus on whether to operate or not. The most often chosen surgical treatment is open reduction and internal fixation as the primary method. Failure of this surgery often needs secondary subtalar arthrodesis as definitive management, so primary subtalar arthrodesis in cases with severe comminution represents definitive treatment in one stage with good functional results. Case outline We present a case of a 54-year-old male patient with a severely comminuted (Sanders type IV) bilateral calcaneus fracture. After the withdrawal of local swelling and disappearance of fracture blisters, the patient was operated on using one-stage bilateral subtalar arthrodesis with percutaneous screw fixation and bone grafting performed through a mini-open sinus tarsi approach. The early postoperative period was uneventful. The patient did not walk for the first seven postoperative weeks, after which rehabilitation was continued with partial weight bearing with a gradual increase of weight-bearing to full over the next five weeks, after which walking aids were completely phased out. Three years after surgery, the patient has no symptoms and has a close-to-normal gait. Conclusion Although this type of injury has traditionally been treated with open reduction and internal fixation, we believe that primary subtalar arthrodesis with bone grafting through a mini-open sinus tarsi approach can benefit patients with severe comminution of calcaneus, allowing good functional results and patient satisfaction, with fewer postoperative complications and faster definitive recovery. © 2024, Serbia Medical Society. All rights reserved.

Introduction/Objective Since tibial shaft is a common location of opened and closed tibial fractures, it is very important to determine the best method of treating these fractures. Our objective was to assess whether the Ilizarov technique is appropriate in terms of complications, outcomes, and pain reduction in treatment of patients with tibial shaft fracture. Methods Retrospective analysis included all consecutive patients with tibial shaft fracture treated with the Ilizarov technique in the period from January 2013 to June 2017 at the Banjica Institute for Orthopaedic Surgery, Belgrade, Serbia. Demographic and clinical data on patients were collected. Pain was assessed using visual analogue scale of pain. Two models of uni-and multi-variate linear regression analysis were performed. Results The study showed that the overall rate of complications was low, and that hypertension, administration of antibiotics, and reoperation prolonged fixation. Also, severe fractures and longer procedure time delay mobilization. Significant reduction of pain was observed. Conclusion The Ilizarov technique is a safe and reliable method in the treatment of patients with tibial shaft fractures and is followed by pain reduction, overall improvement of functioning, good outcomes, and is not commonly associated with complications. © 2020, Serbia Medical Society. All rights reserved.

Introduction. Chopart joint dislocation (CJD) represents a rare injury that is often initially unrecognized. Because of this, but also because of the increased morbidity it leads to, and due to poor treatment outcomes, this injury represents a significant clinical problem. Case report. We present two patients with overlooked CJD admitted to our institution within one year. The first case was a 63-year-old male, who suffered an injury after falling down the stairs, while the second case was a 33-year-old female injured in a traffic accident. Both patients were initially treated under the diagnosis of foot and ankle sprain. Upon their admission and subsequent computed tomography diagnostics, overlooked pure CJD was diagnosed in both patients. They both underwent open reduction and internal fixation of the Chopart joint using K-wires. Six weeks after the surgery, the K-wires were removed, a below-knee orthosis was applied for walking, and partial weight-bearing was allowed with a gradual increase to full weight-bearing over the next six weeks. Physical therapy was initiated. After the six-month follow-up, both patients were successfully rehabilitated, with a final American Orthopaedic Foot and Ankle Society score of 76 out of 100 for the female patient and a score of 84 out of 100 for the male patient. Conclusion. Despite the delayed diagnosis and postponed operative treatment, the functional outcomes of pure CJD treated by open reduction and percutaneous K-wiring can be satisfactory. Additional studies are required to gain a better insight into the prevalence and causative factors of the possible complications in such a treatment approach to the mentioned injury. © 2025 Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.

Background: The purpose of this study was to collect all available randomized controlled trials (RCT) on the treatment of open tibial fractures with an external fixator (EF) and intramedullary nailing (IMN) for meta-analysis to provide reliable evidence-based data for clinical decision-making. Material and methods: The systematic review was undertaken in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and AMSTAR (Assessing the Methodological Quality of Systematic Review). An electronic search of PubMed, Cochrane Library, and Web of Science was performed until 1 March 2023 to identify RCTs which compared either IMN or EF to fix the open tibial fracture. Outcome measures were: postoperative superficial and deep infection, time to union, delayed union, malunion, nonunion and hardware failure. In addition, pain and health-related quality of life were evaluated after 3 and 12 months of follow-up. Results: Sixteen publications comprising 1011 patients were included in the meta-analysis. The pooled results suggested that the IMN technique had a lower postoperative superficial infection and malunion rate (RR = 3.56, 95%CI = 2.56–4.95 and RR = 1.96, 95%CI = 1.12–3.44, respectively), but higher hardware failure occurrence in contrast to EF (RR = 0.30; 95%CI = 0.13–0.69). No significant differences were found in the union time, delayed union or nonunion rate, and postoperative deep infection rate between the treatments. Lower levels of pain were found in the EF group (RR = 0.05, 95%CI = 0.02–0.17, p < 0.001). A difference in quality of life favoring IMN after 3 months was found (RR = −0.04, 95%CI = −0.05–0.03, p < 0.001), however, no statistical difference was found after 12 months (RR = 0.03, 95%CI = −0.05–0.11, p = 0.44). Conclusions: Meta-analysis presented reduced incidence rates of superficial infection, malunion, and health-related quality of life 3 months after treatment in IMN. However, EF led to a significant reduction in pain and incidence rate of hardware failure. Postoperative deep infection, delayed union, nonunion and health-related quality of life 12 months following therapy were similar between groups. More high-quality RCTs should be conducted to provide reliable evidence-based data for clinical decision-making. © 2023 by the authors.

Introduction Extremely rarely, the evolution of abdominal aortic aneurysm (AAA) includes the phase when extravasations of the blood from a ruptured aneurysm is contained by the surrounding tissue, referred to as chronic (contained) rupture of the AAA. Our aim was to call attention to this life-threatening condition, which is always challenging for diagnosis. Case outline A 58-year-old man reported to the Emergency Center for significant abdominal pain. Ultrasound examination showed an infrarenal aneurysm of the abdominal aorta. A computed tomography scan of the thorax, abdomen, and pelvis with iodine contrast in arterial phase was performed. A free gas collection was observed between the liver and the anterior abdominal wall that is traced to a ruptured inflamed diverticulum on the transversal colon. Immediately distal to the branching sites of the renal arteries, the abdominal aorta extended forward and aneurismatically expanded. Posterior left, along the psoas muscle, a rupture of the aortic wall was seen, with an organized hematoma that accompanied the muscle. Between the hematoma and the aortic aneurysm, erosions of the anterior and lateral part of the vertebral bodies L2 and L3 were discovered. The patient underwent endovascular AAA repair (EVAR) and recovered well. Conclusion Multidetector computed tomography angiography is a reliable, non-invasive, and necessary examination for localization and evaluation of the size of the AAA form, its chronic rupture, and complications such as vertebral body erosion. © 2019, Serbia Medical Society. All rights reserved.