Browsing by Author "Slavković, Nemanja (16550887400)"

Chiari pelvic osteotomy is a surgical procedure having been performed for almost sixty years in patients with the insufficient coverage of the femoral head. It is most frequently used in young patients with dysplastic acetabular sockets as a part of developmental hip dysplasia. Even though performance of the Chiari osteotomy is associated with positive therapeutical results, above all, its main goal is to delay inevitable degenerative changes. Original surgical technique has been modified and improved over time. Nevertheless, the basic idea has remained unchanged - increasing of the femoral head coverage by medial displacement of the distal part of the pelvis along with capsular interpositioning. Given the complexity of operation, the complication percentage is rather low. Chiari pelvic osteotomy has lost its actuality and importance during this past six decades. The role of Chiari pelvic osteotomy has been considerably taken over by other more efficient and more lasting surgical procedures. Nonetheless, Chiari pelvic osteotomy is still present in modern orthopedic practice, above all as "salvage" osteotomy.

Introduction/Objective Sprains account for 85% of all ankle injuries. Syndesmosis injuries occur in 1–18% of patients with ankle sprains and are more common in contact sports involving forced foot dorsiflexion. Methods In our study, we compared 30 patients treated with dynamic fixation for acute syndesmotic injury with patients treated with rigid fixation. The criteria for comparison were: American Orthopedic Foot and Ankle Society (AOFAS) Ankle Hindfoot Scale, visual analogue scale (VAS), EuroQol five-dimension questionnaire (EQ-5D), range of motion, complications and reoperations. Results The mean AOFAS score for patients treated with rigid fixation was 88.6, while the mean score for patients treated with dynamic fixation was 91.6. The mean VAS score for rigid fixation was 83.5, while it was 85.8 for dynamic fixation. Infection as a complication of rigid fixation was present in two patients (11.8%), while it was absent in the dynamic fixation group. The need for implant removal occurred in two patients treated with rigid fixation (11.8%) and in one patient treated with dynamic fixation (7.7%). Conclusion Based on our results and the results reported by other authors, we prove that there is a lower incidence of problems related to implants and the need for the implant removal with dynamic fixation, based on the results of AOFAS score, we notice better and faster recovery with dynamic fixation as well. © 2024, Serbia Medical Society. All rights reserved.

Introduction/Objective The knee joint is prone to injuries caused by direct or indirect trauma. The meniscus and ligament injuries, cannot be completely diagnosed with clinical examination; therefore, we use additional non-invasive and invasive diagnostic methods such as magnetic resonance imaging (MRI) and arthroscopy. The aim was to compare the accuracy of MRI and objective knee findings based on arthroscopic examination in case of meniscus and anterior cruciate ligament injuries. Methods The study involved 50 patients treated with elective surgery which mandatory involved arthroscopic visualization of the knee structures. We compared the MRI findings, obtained from different institutions, and arthroscopic knee findings for all the patients involved in the study. Results There were 50 patients included in the study with mean age of 31 years. MRI showed that Anterior cruciate ligament was damaged in 41 patients, while arthroscopy confirmed damage in 43 patients. Medial meniscus was damaged in 31 patients on MRI and in 27 on arthroscopic examination. Lateral meniscus was injured in 35 patients on MRI and arthroscopy showed damage in 32 patients. Using χ2 test we found no significant difference between MRI and arthroscopy as diagnostic methods. Wilcoxon signed-rank test shows similar results between MRI and arthroscopy findings. Conclusion A comparative analysis of MRI and arthroscopy diagnostic value in case of anterior cruciate ligament, medial meniscus and lateral meniscus injuries have shown that there is no significant difference between these two methods. © 2022, 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 Haglund’s deformity represents a reactive enlargement of the posterosuperior aspect of the calcaneus and often causes pain that can significantly disturb everyday activities. If the patient’s condition does not improve after six months of non-surgical treatment, surgical treatment could be taken into consideration. Although Haglund’s deformity is successfully treated by endoscopic calcaneoplasty with a two-portal technique, we decided to apply a slightly newer technique – arthroscopic surgery with a three-portal technique. Case outline A patient with clinically and radiographically confirmed Haglund’s deformity was operated on using arthroscopic calcaneoplasty with a three-portal technique. The postoperative recovery was uneventful and full weight-bearing was allowed after four weeks. A complete return to sports activities was allowed after four months. Conclusion Arthroscopic calcaneoplasty with the three-portal technique proved to be a safe and cost-effective surgical method in the treatment of Haglund’s deformity. There is still not enough data in the literature regarding this type of surgical treatment, but the good postoperative functional results are extremely encouraging since this surgical technique enables faster recovery and fewer postoperative complications. © 2022, 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/Aim. The aim of this prospective nonrandomized study was to test functional results of different surgical strategies in the operative treatment of symptomatic patellofemoral malalignment. Our hypothesis was that immediate extensive surgery does not have serious advantage comparing to “step by step” procedure, regarding the main symptoms and functional end result. We wanted to check whether obtaining ideal surgical patellofemoral congruency is an essential prerequisite for subsidence of the major symptoms of patellofemoral malalignment. Methods. The study included 35 patients with patellofemoral malalignment who had persistant major symptoms: patellar pain and slipping, 3 months after nonoperative treatment. Divided into three groups, they all underwent the realignment surgery, but in different extent and sequence: immediate extensive surgery, step by step surgery, and only proximal realignment. Their overall functional scores as well as major symptoms were assessed at the beginning, after the surgery, and during the 3-years follow-up period and then, compared at the end. Results. There was no significant difference in the functional results among the groups, neither at the beginning (p = 0.1318) nor at the end of the study (p = 0.3996), but the results at the beginning compared to those at the end of the study showed a statistically significant difference in all three groups (p1 = 0.005062; p2 = 0.011719; p3 = 0.000352). The same result was in regard to the major symptoms. Conclusion. The study confirmed that insisting on immediate extensive surgery in order to achieve precise and complete congruency of the patellofemoral joint, did not prove its advantage over the less invasive, individual surgical approach concerning functional scores and major symptoms. © 2018, Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.

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.