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Biomedical subjects

G Cobeljić

Publications and source records attributed to G Cobeljić.

7 recordsLinked to original sources

[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↗

[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↗

[Triple pelvic osteotomy in our practice--eight years later].

Authors have reviewed their eight years long experience with triple pelvic osteotomy. They are explaining the way of introduction of this procedure in everyday clinical practice. Sixty six hips were operated using Tonnis-Vladimirov method in fifty five patients of the average age of 15 years and four months. Treatment results were evaluated, both anatomically and functionally. Anatomic improvement was detected by measuring CE angle of Wiberg. Preoperatively it ranged from -6 to 33 degrees (16,4+/-10,8 degrees), at the end of treatment it ranged from 15 to 68 degrees (43,6+/-11,8 degrees) - the difference has proven to be statistically highly significant (Student test t=-14,36, p<0,01). Functional improvement (absence of waddling gait or limp, as well as better range of motion) was detected in almost all the cases, although the difference wasn't statistically significant. Also, they are presenting some, very rare, complications - asymptomatic pubic and/or ischial nonunion in seven patients.

Adolescent↗

[Medial rotation deformity of the hip in cerebral palsy--surgical treatment by derotation femoral osteotomy].

Medial rotation deformity of the hip is a problem to patients handicapped by cerebral palsy who are able to walk, because the knees point inward during gait ("kissing patellae") and cause falls and frequent injuries, knee and ankle distorsions. The deformity is a result of an increased femoral neck anteversion. The purpose of the paper is to present the results of an original method of precise determination of the degree of rotation for derotation femoral osteotomy. Indications for this operation were set in patients with spastic form of cerebral palsy over 10 years of age, able to walk, who had difficulties in gait and whose lateral rotation was less than 15 along with the medial rotation of over 70 in the hip on the side of the deformity. Twenty hips in 17 patients able to walk were operated on. The average age was 21 (11 - 42), the average follow-up was 11 years (3-17). The assessment of the results was based on the comparison of the rotational abilities of the hip and individual problems before and after the operation. Excellent result was achieved in 12 (70.6%) patients i.e. 15 (75%) hips; good result was achieved in 3 (17.6%) patients i.e. 3 (15%) hips; unsuccessful result in 2 (11.8%) patients i.e. 2 (10%) hips. Complications aroused in 6 patients i.e. 6 (30%) hips. The conclusion is that derotation osteotomy of the femur is a successful procedure for the treatment of the medial rotation deformity of the hip in patients with the spastic form of cerebral palsy who are able to walk. The above mentioned indications must be respected and the original method of determining the degree of derotation applied. Due to a relatively high percentage of complications, e.g. osteitis, the operation is suggested to patients aged 10 to 15 when possible complications can more easily be cured.

Adolescent↗

[Non-specific sacroiliitis].

We present retrospectively five cases of non-specific sacroileitis which were established and treated in Special Orthopaedic Hospital Banjica Belgrade in the period of 12 years, from 1982 to 1994. Patients have been from 17 to 27 years of age. All of them had been treated initially in other institutions under different diagnosis: specific sacroileitis, specific coxitis, specific spondylitis, abscess of gluteal region and discarthrosis and lumboishialgia. All of the patients have been treated by antibiotics, one by tuberculostatics, one surgically by drainage and one by coxofemoral spica cast. In spite of short period of follow up between 1.5 month and 2 years, we have had excellent clinical and laboratory recovery.

Adolescent↗

Surgical prevention of paralytic dislocation of the hip in cerebral palsy.

Paralytic dislocation of the hip in cerebral palsy may be prevented by soft tissue surgery and the results of two procedures are reported. Twenty hips were treated by adductor tenotomy alone and this was unsuccessful in every case. An alternative method was carried out in 42 hips in 25 patients. The procedure combined adductor tenotomy with release of the hip muscles including iliac crest resection, tenotomy of the rectus femoris, recession of the iliopsoas and, when necessary, either release or transposition of the knee flexors. This was much more successful in decreasing migration of the femoral head.

Adolescent↗