Biomedical subjects

A Lesić

Publications and source records attributed to A Lesić.

At least 19 recordsLinked to original sources

PubMed2006

Epidemiology of hip fractures in Belgrade, Serbia Montenegro, 1990-2000.

INTRODUCTION: This study retrospectively determined the incidence rates of hip fractures in Belgrade, Serbia and Montenegro, during the period 1990-2000. MATERIALS AND METHODS: All patients with hip fractures treated at all Belgrade hospitals were identified from the Republic of Serbia's Ministry of Health National Health Care database. Patient demographics, type of hip fracture, and details of the mechanism of injury were collected. The annual incidence rates were calculated with interpolation according to the Belgrade population census of 1991 and 2002. RESULTS: There were a total of 8,904 hip fractures with a mean annual incidence of 51.7 per 100,000 adults (62.2 females and 35.5 males). Mean age at the time of fracture was 67 years (72.6 for females and 59.3 for males), with 64.7% of all fractures occurring in women. There was a significant increase in hip fracture incidence rates over the observed period in females (P = 0.006), but not in males (P = 0.962). Trochanteric fractures predominated, accounting for 53% compared with cervical fractures. In patients over 50 years of age there was an exponential increase in the incidence of hip fractures in both sexes; though more so in females. 91% of hip fractures occurred in these older patients with incidence rates of 143.6 per 100,000 (185.9 for female and 92.2 for male patients). The most common mechanism of injury in the older group was low-energy trauma (70.3%) resulting from a fall from standing height onto a flat surface (same level). Standardizing incidence rates in the older age group to the US 1985 white population gave values of 228 per 100,000 females and 96 per 100,000 males. These incidence rates are similar to those reported in Italy, France and Great Britain, but lower than those in Scandinavian countries. CONCLUSION: In view of growing population numbers and an increase in the proportion of patients aged over 60 years, we can expect an increase in the prevalence of osteoporosis and an increase in the incidence of fragility hip fractures in the future, with resource implications.

Adolescent↗

PubMed2006

Gunshot injury to the face with a missile lodged in the upper cervical spine without neurological deficit.

An unusual case of facial gunshot injury with the missile lodged in the cervical spinal canal, but without any neurological impairment is reported. The extent of tissue damage and missile track termination in a male patient who sustained gunshot trauma to the face was assessed by plain radiography and by CT scans. The patient was treated conservatively and observed for clinical manifestations of neurological deficit for 3 weeks. CT of the head and neck performed 13 years after injury with the three-dimensional (3D) reconstruction of skeletal elements revealed healed fractures of the right nasal bone, the labyrinth of the right ethmoid bone, and position of the missile on the medial aspect of the right lateral mass of the atlas. There was no migration of the missile during this period. This case report of gunshot wound to the face associated with injury of the cervical spine indicated possibility of survival and atypical absence of clinical manifestation that may occur even when a bullet remains in the spinal canal.

Adult↗

PubMed2005

[History of orthopedic surgery in Belgrade--100 years of orthopedics in Serbia (1905-2005)].

The history of orthopedics in Serbia is related to a hand x-ray made in 1905 by dr. Nikola Krstić. The first orthopedic word was founded in 1919, to be enlarged into a full-fledged orthopedic surgical ward of the General State Hospital in 1932. Until 1941, the ward headed by Dr. Nikola Krstić. The Orthopedics course was headed by Dr. Borivoje Gradojević, who also wrote the first textbook in our country in 1934. In 1947, the ward became the Clinic for Orthopedic Surgery and Traumatology in Belgrade which is the orthopedic basis of Serbia, together with the Special Orthopedic Surgery Hospital Banjica, even today.

History, 20th Century↗

PubMed2005

[Modern aspects of shoulder injury treatment].

The article describes injuries of soft and bone structures of the shoulder region, with special emphasis on the following clinical forms: instabilities and luxations of the glenohumeral joint, fractures of the proximal humerus, clavicle and the states of painful shoulder. Fractures and dislocations, but also significant entities - painful states caused not only by fractures but also by minor trauma such as tendinitises and m.supraspinatus tendon and bicipital tendon ruptures are discussed in more detail. Moreover, their consequences - painful and stiff shoulder - as well as modern diagnostic and therapeutic procedures applied in the painful shoulder treatment are also discussed.

Humans↗

PubMed2005

[Modern aspects of the ankle fracture treatment].

The ankle fractures continue to be a topical issue in orthopedic surgery. X-ray diagnostics, but primarily also other modem diagnostic procedures such as CT, MRI, and arthroscopy enable detection of not only fractures but also osteocartilaginous fractures and soft-tissue ligamentary lesions, which are frequent causes of pain and instability of the ankle. The key segment is the posterio-lateral segment and tibio-fibular syndesmosis whose integrity is sometimes only surgically establishable. In the ankle treatment, stable fixation - since recently by means of resorptive osteofixation materials - and early rehabilitation of the operated ankle are aimed at. The open and pylon fractures, as the most severe forms of ankle fractures, are treated by external fixation with minimum internal fixation (hybrid fixation) of the ankle with conversion of the rigid into a dynamic (articulated) external fixator enabling movement and nutrition of the damaged articular cartilage.

Ankle Injuries↗

PubMed2005

[Anterior cruciate ligament (ACL)].

The anterior cruciate ligament or ACL (ligamenturn cruciatum anterius) is often injured, either alone or within complex ligament injuries of the knee. Therefore, the knowledge of detailed anatomic (macro- and micro-morphological) characteristics of this ligament is of key importance in therapy. The anatomy, structure, insertions, vascularization and inervation of the anterior cruciate ligament of the knee are described from the aspect of modern treatment and rehabilitation methods.

Anterior Cruciate Ligament↗

PubMed2005

[Thoracic disc herniation causing myelopathy. Our experience using transthoracic approach].

The authors have reported six cases of thoracal discus hernia in five patients. All the patients have recently been examined in neurosurgery institutions. They had different degrees of neurological deficit, with tendency to aggravation. The same procedure has been applying: thoracotomy, large decompression of neural structures, and obligatory spondylodesis with the patient's own rib. In three cases a full recovery has been achieved, a partial recovery in other two. Complete and definitive paraplegia developed in one patient. The degree of the neurological recovery was between one and two points by Frankel scale. Better results have been obtained where symptoms were present for a short period of time, and myelopathic signs were mild. The follow up period was between 43 and 68 months. Three of the patients have been returned to their professional work. In one patient, three years after the first surgery, there has been diagnosed another discus hernia, one level below. She was treated with the same surgical technique as described, for the second time. Multilevel symptomatic thoracic disc herniations are extremely rare. Although a small series, it is clearly pointed the need to think of a discus hernia, and its early diagnostics and adequate surgical treatment. The first experience with the operative technique described, demonstrated that this procedure is good and justified.

Adult↗

PubMed2005

[Idiopathic avascular necrosis of the femoral head in adolescents--diagnostics and management].

Idiopathic avascular necrosis of the femoral head still represents incompletely explained clinical entity. In the period 1978-2003. we have treated sixteen hips in ten patients with this condition in the IOHB "Banjica". Diagnosis have been founded on clinical and radiographic features, in addition to MRI findings. One patient have been operated, curretaging necrotic part of the femoral head and placing homografts instead. The other fifteen patients have been treated by the same procedure: skin traction for several months following immediate rehabilitation of the hip. The goal of treatement was reducing the pain, increasing the range of movements and preservation of the normal joint space. Evaluation of the treatement was based on unique criteria founded on Howorth-Ferguson index, clinical and radiographic features.The follow-up period was 2-7 years. The authors have stressed the following advantages of the non-operative treatement in adolescents with idiopathic avascular necrosis if the femoral head: increased range of joint movements, decreased pain and low risk rate of any complications following surgical procedures. Formed changes in the femoral head are irreversible, and they are real basic for premature arthrosis of the hip.

Adolescent↗

PubMed2005

[Paralytic hip dislocation in cerebral palsy--soft tissue surgical procedures].

Results of a combination of soft tissue procedures performed for the first time in treating paralytic dislocation of the hip in cerebral palsy are presented. All hip flexors and adductors release, along with possible transposition or elongation of knee flexors on the side of the dislocation (if knee contracture exceeded 20) were peformed. 75 hips in 57 patients were operated on. 54 patients were analyzed. The average age of the patients was 6.6 years, the average follow-up was 7 years. Excellent result was achieved in 33patients (61%), good in 10 (18,6%), fair in 4 (7,4%) poor in 7 patients (13%). Poor results were registered in patients over 10 years of age and in patients with athetosis. Results were assessed according to clinical finding, radiological finding (migrational percentage) and the ability of patients to walk. When based on radiological findings only, excellent results were achieved in 63 hips (84%). This combination of soft-tissue procedures which includes all muscles that take part in the dislocation proved to be very successful in achieving reposition. It can be recommended to patients suffering from the spastic form of cerebral palsy up to 10 years of age.

Cerebral Palsy↗

PubMed2005

[The treatment of "critical ischemia" of the limbs in endarteritis obliterans by thickening of the tibial bone].

The autors report their experience in the treatment of the "critical ischemia" in 8 patients with arterial occlusion of the lower limbs in endarteritis obliterans. All patients were treated by thickening of the tibia using the Ilizarov apparatus for distraction osteosynthesis. In all cases the operative treatment ensured lowering of the amputation level, forming of the functional stump and long-lasting remission of the illness.

Adult↗

PubMed2005

[Nonoperative treatment of fractures of the base of the first metacarpal bone--Bennett fracture].

Although described as early as in 1882, the fracture of the metacarpal bone basis is still a therapeutic challenge for first orthopedic surgeons. Several non-operative and operative methods in the treatment of this fracture have been described. The goal of this paper is to analyze nonoperatively treated patients with Bennett's fracture. A group of 50 patients of both sexes, with the fracture of the first metacarpal bone basis fractures and with the average follow-up of 9 (6-13) years, has been analyzed. After an orthopedic reposition, immobilization lasting 5 weeks was applied, followed by a physical therapy in the duration of 4 to 8 weeks. Numerically, according to Steel, both the subjective and objective state of the hand, as well as an x-ray finding, were assessed. The total hand function was excellent and good in 42 patients, satisfactory in 8, and none of the patients had unsatisfactory function of the hand. Regardless of present degenerative changes, the function of the hand was good, especially if reposition with fragment dislocation less than 2 mm was achieved.

Adult↗

PubMed2005

[Development of degenerative changes in the wrist with pseudarthrosis of the scaphoid bone].

In patients with symptomatic scaphoid nonunion there was an increased evidence of progessive osteoarthrosis expressed as instability of the wrist; it is defined as a scapholunate angle more than 70 degrees or a radiolunate angle of more than 10 degrees. We tried to determine the factors of risk and prognostic indicators of degenerative arthritis. In this study 40 patients with painfull nonunion of the scaphoid were analysed. Duration of nonunion was not in correlation with development of osteoarthritic changes (p=0,644; p>0,05). Progessive degenerative changes correlated well with radiolunate angle (p=0,398; p<0,05), kapitolunate angle (p=0,381; p<0,05) and carpal index (p=0,392; p<0,05). The average values of intercarpal angles increased with progression of osteoarthritic changes. There was a statistically strong corelation between location of fracture in proximal third and presence of degenerative changes (p=0,341; p<0,01). Intesity of arthritic changes showed no statistically significant correlation regarding untreated fractures (p=0,665; p>0,05). We recommend that a scaphoid nonunion associated with carpal instability should be operated before degenerative changes develop.

Fractures, Bone↗

PubMed2005

[Incidence of hip fractures in the population of Belgrade during the period 1990-2000. Projections for 2020].

The aim of this survey was estimation of incidence of hip fractures in the population of Belgrade during the period from 1990 to 2000, as well as the estimation of expected numbers and incidence of hip fractures for 2010 and 2020, based on linear trend models. Our investigation included 8139 subjects (29% males and 71% females) with hip fractures aged 50 and more, who hospitalized at all Clinics and Departmets of Orthopedics and Traumatology in Belgrade, during the period 1990-2000. In epidemiological analysis, sex- and age-specific incidence rates and standardized (according to the US standard population) rates were calculated. The average number of hip fractures in male and female populations of Belgrade aged 50 and more were 214 and 525 new cases per year, respectively (total 739). The average incidence rates were 84.9/100,000 for males, 167.3/100,000 for females, and 118.6/100,000 for both sexes. During the period observed, incidence of hip fractures showed statistically significant increase (y=111.88+3.11x, p=0.024), especially among females (y=135.94+5.23x, p=0.007). Age-specific incidence rates of hip fractures strongly related with age, and the highest values were registrated in the age group 80 and more for both sexes (505.2/100,000-for males and (1042.8/100,000 for females). Among Belgrade inhabitants aged 50 and more, the increasing number of hip fractures could be expected up to 2020, 23.7% for males and 128.8% for females.

Aged↗

PubMed2005

[External fixation of war injuries of the proximal femur].

Seventeen patients with open fractures of the upper third of the femur were treated using a pelvifemoral external fixation device. All of them had grade III open fractures resulting from high-velocity missile and explosive injuries with massive foreign body contamination. Sciatic nerve injury was present in five (29.4%); abdominal viscera and thoracic wall injuries were present in two patients (11.8%). There were no major arterial injuries. Full weight bearing was allowed after clinical and radiological bone healing (average 11.5 months). Chronic osteitis with fistula and sequestra developed in two (11.8%) patients. There were no nonunions and no refractures. Minor painless limitation of hip motion persisted in all patients. Upper-third femoral open fractures due to firearms are a unique type of open fractures. They are usually highly comminuted; therefore, stable fixation is difficult or impossible to achieve using external fixation with transfixation of the fracture site. On the other hand, the risk of infection is high following intramedullary nailing. Pelvifemoral external fixation allows adequate management of the soft tissue wounds, provides stable bone fixation and allows early patient mobilization.

Blast Injuries↗

PubMed2005

New concept in external fixation.

A new concept in external skeletal fixation is presented. A 3D unilateral system developed by Mitkovic has widely been investigated biomechanically in AO institute in Davos (Switzerland). Consists of three components only providing extremely simple application and dynamic fixation of bones and different joints. This simple external fixator functions as an accurate reduction device at the same time, minimizing need for fluoroscopy. Clinically this system has been applied to mere then 13 thousand patients in 43 clinics. This paper presents the results of its application for treatment of open fractures, war wounds with fractures and for comminuted and intraarticular closed fractures in the series of 597 patients. Overall average time for union time was 3.2 months. Overall success of fracture healing was 96.8% including open and closed fractures. Our study suggests that the use of this 3D unilateral system is suitable for routine use.

Adult↗

PubMed2005

New biological method of internal fixation of the femur.

One of the main goals in fracture treatment is reservation of both intramedular and periosteal vascularisation. The aim of this paper is to show a new method of internal fixation which accomplishes these goals. The paper presents the results of clinical application of Mitkovic Internal Fixator, new self-dynamisable device, which provides fixation of the femur using minimally invasive technique. This device has been investigated experimentally on 60 animals. It has been applied to 267 patients. Here is presented a series of 92 fixations of femoral diaphyses after fresh fractures and after unsuccessful treatment using other methods. Follow-up was 3.1 years (2 to 7 years). Bone healing was achieved in all patients within 3.5 months (2.7-9 months) with big amount of periosteal callus formation. There were no complications in all patients seen. It can be concluded that this method and device meet biological and biomechanical requirements for safe fracture treatment.

Adolescent↗

PubMed2005

[Congenital pseudoarthrosis of the tibia treated with the free microvascular fibula].

Congenital pseudoarthrosis (CPT) of the lower leg is still a considerable therapeutic problem. There are many surgical and other procedures to manage pseudoarthrosis, but the results are not always satisfactory, unfortunately, and are accompanied by a big number of complications, even limb amputation in some cases. The most complicated surgical procedure is transplantation of the autogenous free microvascular fibula coil which has had the best results momentarily. We are showing a case of a 2.5-year old patient with congenital pseudoarthrosis of the lower leg previously treated unsuccessfully by a conventional surgical method. This is at the same time the first case of such operative treatment of CPT in the territory of Serbia and Montenegro as well as former Yugoslavia. The patient was operated in October 1992.

Child, Preschool↗

PubMed2005

[Treatment of gigantocellular tumor of the tibia metaphysis by means of the Ilizarov method--a case study].

The authors show a 36-year old female patient with a gigantocellular tumor of the distal metaphysis of the left tibia (stage III by Campanacci). A 7.6 cm long distal articular defect of the tibia has been formed by radical segmentary resection. The defect was compensated by the extension of the rest of the tibia; whereas the support function of the limb was provided through tibio-talar arthrodesis. 5.5 years after the surgery, there are no signs of local relapses; the patient walks without any orthopedic aids and works at the same job as prior to the operation.

Adult↗