Browsing by Author "Jovanović, Vesna (58709193500)"

Introduction: Injuries of the distal femur are rare in children; however, they are frequently associated with complications. They are almost always physeal, most frequently Salter-Harris type II epiphyseolysis. The treatment of such injuries is similar in all physeal injuries. It is intended to provide growth plate recovery by gentle reduction and stable fixation thus preventing secondary complications, and also to provide decompression of the segment to solve the compartment syndrome and recover the neurovascular structures. Case Outline: A seven-year old boy presented with a right knee injury while sleigh riding. He was admitted three weeks following the injury with distal femoral epiphysiolysis associated with peroneal palsy. A day after admission to our Institute the reduction was performed using the Ilizarov device. Physical therapy was started immediately after surgery, as well as walking with weight bearing on the operated leg. Five months after surgery the patient was anatomically and functionally recovered. Conclusion: The presented method is recommended in the treatment of such injuries because of several reasons; reposition is simple and complete, there is no need to open the fracture site, fixation is stable, the growth plate is preserved, there is no need for additional external immobilisation, and physical therapy involving walking with weight bearing on the operated leg may be started immediately after surgery.

Introduction SWOT analysis is a managerial tool used to evaluate internal and external environment through strengths and weaknesses, opportunities and threats. Objective The aim was to demonstrate the application of the SWOT analysis on the example of the Department for Paediatric Orthopaedics and Traumatology at the Institute of Orthopaedic Surgery "Banjica" in Belgrade. Methods Qualitative research was conducted during December 2008 at the Department for Paediatric Orthopaedics and Traumatology of the Institute of Orthopaedic Surgery "Banjica" by applying the focus group technique. Participants were members of the medical staff and patients. In the first phase of the focus group brainstorming was applied to collect the factors of internal and external environment, and to identify strengths and weaknesses, opportunities and threats, respectively. In the second phase the nominal group technique was applied in order to reduce the list of factors. The factors were assessed according to their influence on the Department. Factors ranked by the three point Likert scale from 3 (highest impact) to 1 (lowest impact). Results The most important strengths of the Department are competent and skilled staff, high quality of services, average hospital bed utilization, the Department providing the educational basis of the School of Medicine, satisfied patients, pleasant setting, and additional working hours. The weaknesses are: poor spatial organization, personnel unmotivated to refresh knowledge, lack of specifically trained personnel, inadequate sanitary facilities, and uncovered services by the Insurance Fund, long average hospital stay, and low economic status of patients. The opportunities are: legislative regulations, formed paediatric traumatology service at the City level, good regional position of the Institute, and extension of referral areas. The threats are: absent Department autonomy in the personnel policy of the Institute, competitions within the Institute, impossibility to increase the Department capacities, inadequate nutrition, low opportunities for expert training of the personnel, outdated equipment, and presence of informal payments. Conclusion SWOT analysis is a frequently used managerial instrument, which enables the systematic approach in decision making process.

Introduction A Monteggia lesion is a dislocation of the radial head associated with a fracture with the proximal third of the ulna. It is rare in children and the dislocation of the radial head is often missed at the time of injury. There are a lot of described treatment methods: open reduction of the radial head and reconstruction of the annular ligament combined with ulnar osteotomy, the same method without reconstruction of the annular ligament, gradual lengthening and angulation of the ulna by Ilizarov method without the opening of radiocapitye{cyrillic}lar joint. Case Outline A 14-year-old boy had been diagnosed with Monteggia lesion type Bado II three years before the admission to hospital. Previously nonoperatively treated, the missed radial head dislocation Bi-phase treatment had been done. Firstly, the distraction Ilizarov device was placed on the forearm, corticotomy of the ulna was done, distraction lasted fifteen days. Secondly, after achieving 1.5 cm of new bone and good level of the radial head, a reduction mechanism was incorporated into the Ilizarov device. The radiocapitelar joint was not opened, the reconstruction of the annular ligament was not done. After the radial head reduction and new bone maturation (1.5 months), the Ilizarov device was taken off. Conclusion The described method of treatment has several important advantages: radial head reduction may be done without the joint opening, the recovery is very fast and easy after that; the elbow and forearm appear cosmetically very well after the operation; the treatment process is short, the arm is in use all the time, the absence from school is not needed, the achieved result is permanent.

Introduction: Septic pseudoarthroses of the tibia represent a relatively frequent complication of open fractures with a large soft tissue damage. They may be localized: in the proximal metaphysis, between the proximal and middle thirds, between middle and distal thirds, in the distal metaphysis. Case Outline: A case of a 52-year-old man with open fracture of the left tibia is presented. He fell from the height of 30 meters. The external fixation according to Mitkovic was performed in another institution. The patient was referred to our hospital nine months after the accident, with clear clinical and radiological signs of septic pseudoarthrosis of the tibia. The resection of septic pseudoarthrosis was done two weeks after admission. Three weeks later, another operation was performed, bilocal alternating distractive-compressive osteosynthesis according to Ilizarov. After eleven months Ilizarov frame was removed, with clinical, radiological signs of healing of pseudoarthrosis and complete curing of the infection. Five months after removal of the frame, the patient was fully anatomically and functionally recovered. Conclusion: Being satisfied with the achieved results and encouraged with the data from the literature, we recommend this method as the method of choice for the treatment of pseudoarthrosis of the tibia. The advantage consists of curing the infection using the natural bactericide power of the tissue and curing the bone defect, at the same time, and finally, producing the equalization of the legs.