Biomedical subjects

V Zdravkovic

Publications and source records attributed to V Zdravkovic.

13 recordsLinked to original sources

PubMed2004

[Late reconstruction of distal biceps tendon rupture with fascia lata graft and Mitek anchors].

Ruptures of the distal biceps tendon are rare but well documented. A technique for reinserting the distal biceps tendon into the radial tuberosity with two Mitek anchors and a fascia lata graft is presented and illustrated by a case report. Ectopic ossification as a complication after the procedure is discussed as well as the final outcome. It could be concluded that late reconstruction of the distal biceps tendon rupture with fascia lata and Mitek anchors is a safe procedure that can be advocated in a restricted number of cases where acute injury has been overlooked.

Adult↗

PubMed2004

Presentation and course of Type 2 diabetes in youth in a large multi-ethnic city.

AIM: To review the clinical experience of children and teens diagnosed with Type 2 diabetes (T2DM) at a paediatric hospital serving a large urban multi-ethnic population. METHODS: Retrospective chart review of patients with T2DM followed in the diabetes clinic at the Hospital for Sick Children (HSC) over an 8-year period. Patients who were included were younger than 18, referred at the onset of diabetes, and where presentation and/or clinical course was 'typical' of T2DM. RESULTS: Of 1020 children with diabetes followed at HSC, 4% were identified as having T2DM in 2002. There was a sixfold increase in new cases from 1994 to 2002. The mean age at diagnosis was 13.5 +/- 2.2 years (range 8.8-17.5) with a female-to-male ratio of 1.7. Most had a first- or second-degree relative with T2DM. There was an overrepresentation of children with T2DM from Asian and African Canadian ethnic groups relative to the regional population. The majority of teens were asymptomatic at presentation, with a smaller number in diabetic ketoacidosis (DKA) at diagnosis. Mean HbA1c at diagnosis was 10 +/- 3.4%. Approximately one half of patients were initially treated by diet and exercise with many requiring intensification of therapy over a short period of time. CONCLUSIONS: We report a similar increase in T2DM incidence and clinical presentation at HSC to other clinic reports in large North American urban centres. Of note is the high prevalence of children of South/South-East Asian descent.

Adolescent↗

PubMed1997

A new radiographic method of measuring carpal collapse.

We assessed carpal collapse by measuring the capitate-radius (CR) distance on standard plain radiographs. This new method required validation of diagnostic accuracy, so we compared it with the method of Nattrass et al known as revised carpal height (RCH). We studied wrist radiographs from 16 normal subjects and 11 patients with unilateral Kienböck's disease. We found that there was a significant difference in the left/right CR index between the normal wrists and those with Kienbock's disease (p < 0.001). The use of left/right RCH index showed no significant difference (p = 0.30). Diagnostic accuracy was shown to be higher for the CR index using ROC curves. We then assessed 40 normal wrists and found the mean CR index to be 0.999 +/- 0.034, and suggest that values less than 0.92 are abnormal. The CR index can be used for diagnosis in unilateral carpal collapse, and for monitoring progress where the condition is bilateral.

Adult↗

PubMed1997

Wrist arthroscopy: a prospective analysis of 53 post-traumatic carpal injuries.

We carried out a prospective study of 53 consecutive patients who had sustained a serious wrist injury. Patients who presented with a previous condition or who had undergone surgery to the wrist were excluded. History, clinical findings, standard radiographs and arthrography were correlated with the uninjured side and with arthroscopic findings. The radiolunate (RL) angle of the injured wrist differed significantly from that of the "normal" wrist (p = 0.088). POssible correlations within the whole group were studied by multivariate analysis, particularly k-means clustering, a procedure which enables the detection of natural groups. We found that ligamentous tears at the triquetrum in the midcarpal joint significantly (p = 0.004) affected the equilibrium of the proximal row defined by clustering with the RL and scapholunate (SL) angles. The use of multivariate analysis techniques in combination with cross tabulation for the surgery of intracarpal ligamentous abnormalities seen at arthroscopy might help us to define better the function of the ligaments of the wrist. These findings, of little help in daily practice, might be important for clinical research.

Adult↗

PubMed1996

The value of arthroscopy in the evaluation of carpal instability.

In a prospective study, arthroscopic examinations were performed on 42 wrists following injury. Clinical findings, radiology, and arthrography were compared to the arthroscopic findings. Only obvious or total ligamentous ruptures found on arthroscopy were considered in the analysis. No direct correlation could be demonstrated with clinical findings or arthrography. The distribution pattern of ligament injury involving the radial and ulnar compartment of the wrist joint in 40% of the cases suggests that carpal dysfunction following injury and ligamentous tears is a more complex problem than usually accepted. The ulnar midcarpal joint seems more prone to injury than the radiocarpal portion of the wrist. This suggests an important biomechanical function of the palmar ligaments inserting on the triquetrum.

Adolescent↗

PubMed1995

Physical equilibrium of the normal wrist and its relation to clinically defined "instability".

The rotational stability of the proximal carpal row was tested on six unembalmed human cadaver hand specimens. The physiological load conditions were stimulated by loading the wrist flexor and extensor tendons. Pure torque was introduced to the lunate, scaphoid and triquetrum, one at a time, by means of a dynamometer wrench, forcing the bones loaded to perform a flexion-extension motion. A truly stable state of equilibrium could be found in the normal wrist only under axial load. A uni-directional coupling was observed through the scapho-lunate ligament as a counteraction to a tendency for the lunate to extend and the scaphoid to flex. The triquetrum and lunate moved together, showing close coupling in both directions. As conclusion: a stable wrist can be defined as one which, while being loaded within a physiological range of stress, does not deviate from a stable state of equilibrium (the ability to return to a single position when disturbed) at any point within the whole physiological range of motion.

Carpal Bones↗

PubMed1995

A new technique of reattachment after traumatic avulsion of the TFCC at its ulnar insertion.

One female and seven male patients (median age 25.5) presented with traumatic avulsion of the triangular fibrocartilage complex (TFCC), type 1B according to Palmer's classification. Reattachment of the TFCC near its anchoring point was combined with an intraarticular shortening osteotomy of the ulnar head. This provides an excellent approach to the TFCC and a well vascularized anchoring surface. The mooring point is biomechanically appropriate and the tissues with the best biomechanical properties are used. The functional results with a mean follow-up of 3 years were encouraging, as demonstrated by the significant improvement of pain (P = 0.017). All patients were able to return to their previous occupation; no further surgery was necessary to the distal radio-ulnar joint and no impairment of pronation and supination was detected. The final wrist score reflects the subjective results defined by the patient. However the correlation is not linear and the wrist scores are superior to the degree of satisfaction defined by the patient.

Adolescent↗

PubMed1994

The palmar wrist ligaments revisited, clinical relevance.

In fifteen cadaver wrists and ten foetus wrists palmar ligaments were studied. As a result, the palmar scapho-triquetral ligament was presented by means of gross anatomical study, MR imaging, and histological study. A kinematic study was conducted on three cadaver wrists to analyze patterns of motion on the proximal carpal row bones based on the helical axis concept. Motion analysis showed that the scaphoid has a set of helical axes bundled at the radial side of the wrist. On the contrary, the triquetrum had axes bundled on the ulnar side, approximately in the same position as the lunate. That shows that the lunate and triquetrum are coordinated in motion and opposed to that of the scaphoid. The structure possibly ruling this pattern of motion could be the palmar scapho-triquetral ligament, whose insertions on the scaphoid and triquetrum are close to the crossing-point of the helical axes of the scaphoid and triquetrum/lunate, respectively. In order to study the clinical relevance of our findings, a prospective clinical study on 53 patients after wrist injury was conducted. All patients were clinically examined, simple and semi-stress X-rays were taken, and arthrography and arthroscopy performed. Ligament tears were often found, but any correlation to clinical findings or arthrography could not be found. However, high correlation could be found between the lesion of the palmar scapho-triquetral ligament and a DISI position of the lunate combined with increased scapho-lunate angle. It can be concluded that the tear of the palmar scapho-triquetral ligament causes instability pattern that is radiologically evident at an early stage.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1994

The anatomy of the palmar scaphotriquetral ligament.

The palmar ligaments of the wrist were dissected in 15 adult cadaver wrists and demonstrated by MRI in three. Ten fetal wrists (10 to 19 weeks' gestation) were studied in histological sections. The palmar scaphotriquetral ligament was found in them all. Its attachment to the triquetrum is substantial but that to the scaphoid is thin and fan-shaped, its fibres interdigitating with those of the radioscaphocapitate ligament. The contribution of the ligament to carpal stability has yet to be studied, but it may help to support the head of the capitate when the wrist is dorsiflexed.

Adult↗

PubMed1993

Kinematic analysis of relative motion within the proximal carpal row.

The motions of the scaphoid and triquetrum relative to the lunate have been studied on cadaver specimens. The helical axis concept was applied. The wrist motions performed were flexion-extension and radial-ulnar deviation. The results showed increased relative motion of the scaphoid towards terminal extension, and to a lesser amount in the case of the triquetrum, towards terminal flexion. The lunate might be considered as a keystone in the proximal carpal row when wrist stability is considered. It is doubly intercalated: longitudinally and transversely. Wrist ligaments co-ordinate the positioning of the bones in the mid-range of carpal motions, and restrict further motion in extreme positions of the wrist joint.

Cadaver↗

PubMed1993

Kinematics of the wrist and its ligaments.

Precise anatomic dissections of unembalmed physiologically intact cadaver specimens were carried out before proceeding with the kinematic investigations on further specimens. Carpal flexor and extensor tendons were used to move the wrist. The analysis of the carpal bone movements was performed according to the finite helical axis motion concept for increments of 10 degrees for each main carpal motion. Separate axes of rotation for each of the bones in the proximal carpal row were found; however, the axes for the lunate and triquetrum bones were close, and the magnitudes of rotation and translation almost equal. One finding was that the axes of rotation of the bones in the proximal carpal row often cross at some particular point. Because the axes of the scaphoid are differently oriented than those of the lunate and triquetrum, shear might occur during wrist motion. This indicates also that the scaphoid and lunate cannot be considered rigidly coupled elements. We also assume that the individual bones of the proximal carpal row self-align themselves as long as they are not constrained by torsion. Several potential mechanisms of flexion motion of the proximal carpal row during radioulnar deviations of the hand were considered. The ligament function is still an unsolved problem. Compensation mechanisms may mask clear correlations between a lesion and the instability pattern associated with it. The proximal carpal row should be studied as one system.

Cadaver↗

PubMed1993

[Pathophysiology of perilunate dislocation].

The anatomy of the palmar scapho-triquetral ligament was studied: on 15 hand specimens by means of gross anatomical dissections and MR imaging; and on a further 10 foetal wrist specimens, microanatomically. This ligament allows us to present the proximal carpal row as a socket, consisting of an upper part (the triquetrum, distal part of the scaphoid, and the dorsal and palmar scapho-triquetral ligament), and a base (the concave parts of the lunatum and scaphoid, connected by the scapho-lunate ligament). With a hyperextension wrist injury the upper part follows the distal part of the carpus, while the base remains fixed at the radius. The upper part slips away from the base, consequently, injuring the ligamentous structure, or causing a scaphoid fracture. The luno-triquetral and the palmar scapho-triquetral ligaments are also frequently torn. The overall prognosis depends on the grade of ligament damage. The arthroscopy allows us to estimate the state of the ligament structures, therefore, it is indicated before any reconstructive operation.

Adult↗

PubMed1990

Computer-assisted preoperative planning (CAPP) in orthopaedic surgery.

Computer-assisted preoperative planning (CAPP) is a complex approach to planning a surgical treatment. It includes computer-assisted design (CAD) principles, expert knowledge utilization and facilities for decision making process support. The CAPP system uses actual patient data and calculates instructions in real dimensions for performing a particular operation on a particular patient. Our first CAPP application was preoperative planning of corrective osteotomy of a malunited fracture at the distal end of the radius. The application was based on the construction of three-dimensional wire models from only two orthogonal projections of objects (two orthogonal X-rays of affected and healthy wrists). On these wire models, an operation of the affected hand was simulated until the best fitting of the models was achieved. The use of real dimensions in computer calculation was crucial because the numerical output was used as a surgical treatment guideline. The results obtained in a group of 33 patients were excellent when compared with the results reported in the literature.

Adolescent↗