Biomedical subjects

Milorad Mitkovic

Publications and source records attributed to Milorad Mitkovic.

3 recordsLinked to original sources

PubMed2006

External fixation of open subtalar dislocation.

Subtalar dislocation is a rare and severe injury, caused by high-energy trauma such as fall from a height or traffic accident. Infection and avascular necrosis are not rare sequelae of open subtalar dislocation, and the outcome may be poor. External fixation allows complete wound care, and moderate distraction of the ankle joint should unload the talus, which may reduce the risk of avascular necrosis. We treated 11 open subtalar dislocations by distractional external fixation. The series involved nine males and two females, of average age 30.39 years. In nine cases the injury was caused by falling from a height, and in two by a traffic accident. The follow-up period ranged from 18 to 28 months. The final functional results were good, with no infection and one case of avascular necrosis of the talus. Pain after a longer period of walking or standing was experienced by eight patients, and movement of the subtalar joint was limited in nine patients. Immediate distractional external fixation of open subtalar dislocation may prevent infection and avascular necrosis of the talus.

Adult↗

PubMed2006

Treatment of blast injuries of the extremity.

Blast trauma is a complex event. Pathophysiologically, blast injuries are identified as primary (caused solely by the direct effect of blast overpressure on the tissue), secondary (caused by flying objects or fragments), tertiary (caused by bodily displacement), or quaternary (indirectly caused by the explosion). The range of primary blast injuries includes fractures, amputations, crush injury, burns, cuts, lacerations, acute occlusion of an artery, air embolism-induced injury, compartment syndrome, and others. Secondary injuries are the most common extremity blast injuries. Like primary injuries, they may necessitate limb amputation, be life-threatening, and produce severe contamination. Tertiary blast injuries of the extremity may result in traumatic amputations, fractures, and severe soft-tissue injuries. Quaternary injuries most often are burns. Following treatment and stabilization of immediate life-threatening conditions, all patients are given antibiotic and tetanus prophylaxis. Débridement and wound excision are started as early as possible, with repeat débridement performed as necessary; fasciotomies also are performed to prevent compartment syndrome. Well-vascularized muscular free flaps provide soft-tissue coverage for blast-injured extremities. The closed-open technique of flap closure allows reexamination of the wound, further irrigation, débridement, and later bone and soft-tissue reconstruction.

Blast Injuries↗

PubMed2004

Open subtalar dislocation treated by distractional external fixation.

Subtalar dislocation is a rare injury, constituting approximately 1% of acute dislocations, and often is the result of high-energy trauma, particularly falls from heights. We present a case of a 33-year-old man who sustained a Gustilo type IIIB open subtalar dislocation when he fell 4 m from a scaffold. After irrigation and debridement, a Mitkovic distractional external fixator was applied medially for 6 weeks while the wound healed by secondary intention. Physical therapy was initiated along with partial to full weight bearing during the next 3 months. The patient returned to work at 8 months postinjury. At 24 months, the patient had a normal gait with pain only during prolonged periods of standing or walking. X-rays and MRI were normal with no signs of avascular necrosis or posttraumatic arthritis. Ankle joint range of motion was dorsiflexion 5 degrees and plantar flexion 45 degrees with moderately limited subtalar joint motion. The distractional external fixator allowed for complete wound care and unburdening of the talus, which perhaps reduced the possibility of avascular necrosis.

Adult↗