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Search Results: 1 - 10 of 464786 matches for " Milenkovi? Sa?a "
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ADVANTAGES OF SURGICAL TREATMENT OF ACHILLES TENDON RUPTURE BY PERCUTANEOUS SUTURE AS OPPOSED TO NONSURGICAL TREATMENT
Goran Vidi?,Vesna Milojkovi?,Saa Milenkovi,Saa Stojanovi?
Acta Medica Medianae , 2010,
Abstract: The Achilles tendon is the strongest tendon in the body, and its rupture appears to be the most common injury of the tendomuscular apparatus. This type of injury is more frequent in sportsmen, especially those who play tennis, gymnastics, skiing, handball, football, basketball and athletics. Also, the ruptures are common in people who engage in sports activities for recreation. They appear more often in males, in proportion of 3:1. It appears reciprocally in 25- 30% of the cases. The rupture is easily diagnosed by means of clinical examination (Thompson's test) and ultrasonography.The aim of the analysis was to point to the advantages of surgical treatment of a fresh Achilles tendon rupture as opposed to non-surgical treatment by plaster immobilization.The examination was performed on 35 patients, of which 16 (45,71%) were treated operatively and 19 (54,29%) were treated nonoperatively. The average age of the patients was 38.8 years, that is 37.1 for those treated operatively and 40.2 for those treated nonoperatively. Among the examinees, there were 29(82,86%) men and 6 (17,14%) women. The operative treatment method consisted of percutaneous suturing, whereas the nonoperative treatment involved the circular above the knee plaster immobilization. All operatively treated patients underwent the surgical treatment in the first 48 hours from the time when the injury had occured. Anesthesia was local and infiltrative.The obtained results showed that there were no unhealed ruptures or re-ruptures. In the group of patients who did not undergo the surgery, there was 1 re-rupture and 1 unhealed rupture, after which the surgical treatment had to be performed in both cases. In the group of operated patients there were no infections, however, 1 thromboembolism occured. Recovery of muscular strenght of the tendon and the realization of the full range of movement required less time in the operated patients. The ultrasonographic findings in the operated patients showed better consolidation of the rupture site, with less scar tissue formation.The conclusion, as a result of our experience, is that in the case of a fresh Achilles tendon rupture the priority must be given to surgical treatment by percutaneous suture, and each time when it is not possible to bring the ends of the tendon together.
Open wedge osteotomy and callus distraction by means of the external fixator in distal femur and proximal tibia in knee arthrosis with valgus and varus deformity
MilenkoviSaa,Mitkovi? Milorad B.,Radenkovi? Mile,Stanojkovi? Miodrag
Srpski Arhiv za Celokupno Lekarstvo , 2004, DOI: 10.2298/sarh0410318m
Abstract: Various methods can be applied for treatment of knee deformity. One of them is open wedge osteotomy and callus distraction by means of the external fixator. This paper presents the results of treatment of 16 patients with knee arthrosis associated with varus and valgus deformities (10 varus and 6 valgus deformities). Open wedge osteotomy of the varus deformity was performed in the proximal tibia, and in case of the valgus deformity in the distal part of the femur. The patients who were operated on had a knee varus larger than 10 degrees and a knee valgus larger than 12 degrees. Prior to open wedge osteotomy and application of the external fixator, knee arthroscopy was performed (meniscectomy, cartilage drilling and shaving, debridement, the extraction of loose bodies). After one-year follow-up, the final outcome of the treatment was positive in all patients. The treatment alleviated the pain in these patients. The method is minimally invasive and relatively easily applied. Mitkovic's external fixator type M20-CD-V allows for continuous callus distraction with simultaneous correction of the varus or valgus knee deformity.
Surgical treatment of displaced acetabular fractures
MilenkoviSaa,Saveski Jordan,Radenkovi? Mile,Vidi? Goran
Srpski Arhiv za Celokupno Lekarstvo , 2011, DOI: 10.2298/sarh1108496m
Abstract: Introduction. Acetabular fractures are severe injuries, generally caused by high-energy trauma, most frequently from traffic accidents or falls from heights. Fractures of the extremities, head injuries, chest, abdomen and pelvic ring injuries are most commonly associated injuries. Objective. The purpose of this study was to evaluate the results of open reduction and internal fixation of acetabular fractures. The open anatomical reduction of the articular surface combined with a rigid internal fixation and early mobilisation have become the standard treatment of these injuries. Methods. We conducted a retrospective analysis of 22 patients of average age 43.13 years. The patients were treated by open reduction and internal fixation at the Orthopaedic Clinic of Ni from 2005-2009. The follow-up was 12 to 60 months, with the average of 21.18 months after surgery. Results. All injured patients were operated on between 4 and 11 days (5.7 days on the average). According to the classification by Judet and Letournel, 15 (68.18%) patients had an elementary acetabular fracture, whereas 7 (31.82%) patients had associated fracture. A satisfactory postoperative reduction implying less than 2 mm of displacement was achieved in 19 (86.36%) patients. The radiological status of the hip joint, determined according to Matta score, was excellent in 15 (68.18%) patients, good in 4 (18.18%) patients and moderate in 3 (13.63%) patients. According to Merle d’Aubigné Scale, the final functional results of the treatment of all operated patients were excellent in 12 (54.54%) patients, good in 7 (31.81%) patients and moderate in 3 (13.63%) patients. Conclusion. Surgical treatment of dislocated acetabular fractures requires an open reduction and a stable internal fixation. Excellent and good results can be expected only if anatomical reduction and stable internal fixation are achieved.
Surgical treatment of the aseptic femoral shaft nonunion
MilenkoviSaa,Mitkovi? Milorad,Stanojlovi? Milo?,Mi?i? Ivan
Acta Chirurgica Iugoslavica , 2011, DOI: 10.2298/aci1104075m
Abstract: Femoral shaft nonunions is difficult complication and a big challenge for the orthopaedic surgeons. These complications occur after open femoral fractures, comminuted fractures, segmental fractures, the infection, after the inadequate fixed osteosynthesis, the systemic disease, and smokers. The paper presents the results of treatment aseptic femoral shaft nonunion in 18 patients. They were primarily operated by the method of internal compresive plate fixation and external fixation (open fractures). For fixation we used dinamic internal fixator by Mitkovic. All nonunions treated by this method are healed. In patients with atrophic femoral shaft nonunions in addition to fixation was performed and bone grafting. This implant has proved successful in the treatment of femoral shaft nonunion. During the fixation no periostal and intramedullary vascularization damage, which is an important prerequisite for bone healing. Implant enables biological and mechanical conditions for nonunion healing.
Late Diagnosed Cervical Spine TBC Spondylitis: Case Report
Saa Milenkovi,Jordan Savesk,Ilir Hasani,Neda Trajkovska
Acta Facultatis Medicae Naissensis , 2012,
Abstract: Cervical tuberculosis is a rare disease with a high complication rate. Tuberculosis of the cervical spine is reported in about 6-9% of all cases of spinal tuberculosis. Early diagnosis and treatment of spinal tuberculosis is essential in order to prevent neural deficit. Management strategies for spinal tuberculosis range from ambulatory chemotherapy to radical surgical debridement with fusion. The paper presents a case of an 18-year-old patient with TBC spondylitis C3-C5. Eleven months passed from the onset of the disease until surgery and final diagnosis. When hospitalized, the patient suffered from the overall weakness, a 15-kg weight loss, dysphagia, neck pain, neck rigidity, febrility, cervical radiculopathy and paresthesia of both upper extremities. MR image showed a complete destruction of C3, abscess perforation in the anterior epidural space with the spinal cord compression and abscess extension to prevertebral space from C2 to C5. After the radical surgical debridement of C3-C5 and anterior decompression, a tricorticate autologous bone graft obtained from the iliac crest was placed and a plate fixation was done. Tuberculostatics were included for 12 months after surgery. Complete recovery occurred six months after surgery. Anterior decompression with autologous iliac bone graft led to a good clinical and radiological outcome in patients with cervical spine tuberculosis.
Transpedicular screw fixation of thoracolumbar spine fractures
Saa Milenkovi,Jordan Saveski,Neda Trajkovska,Goran Vidi?
Acta Facultatis Medicae Naissensis , 2010,
Abstract: Thoracolumbar spine fractures are most common in the young healthy population. The most common causes of these fractures are high-energy traumas, traffic accidents or falls from heights. Fractures can be followed by neurological damage, which is a dir-ect consequence of the spinal cord damage. Fractures are treated with surgical or non-surgical methods. The best results can be obtained by surgical treatment. Transpedicu-lar screw fixation is one of the methods of surgical treatment. The aim of the paper was to evaluate the initial results of the application of the posterior transpedicular screw fixation in the treatment of unstable fractures of the thoracolumbar spine segment, without neurologic injury. Patients were operated on at the Orthopaedic and Traumatology Clinic Ni and in the Traumatology Clinic Skopje. Fractures were classified according to the AO classification. The severity of the injury was determined by means of Thoracolumbar Injury Severity Scale - TLISS. Two types of the internal fixator for the transpedicular srew fixation, Expidium (Johnson&Johnson) and Xya (Stryker) were used for the frac-ture fixation. The paper presents the results of the transpedicular screw fixations of the thora-cic and lumbar vertebrae in 16 patients, with mean age 45.06 years. There were three patients with Th 12 fractures, five patients with L1 fracture, seven patients with L2 fracture and one patient with L4 vertebral fracture. There were five fractures of A2 type and eight fractures of A3 type. We had one patient with B1 fracture and two patients with B2 fracture. There was one mechanical complication and one superficial infection in an early phase of post-operative recovery. The mean follow-up period was 14.12 months. The final functional results were good in all patients. By applying the transpedicular screw fixation of the unstable fractures of the thoracolumbar spine segment, a stable fracture fixation can be accomplished, that is, by applying distraction or ligamentotaxis, medular canal decompression is achieved. This kind of fixation prevents the possibility of the occurrence of secondary spine deformities and enables quick recovery of surgically treated patients.
VITAMIN D STATUS IN WOMEN WITH POSTMENOPAUSAL OSTEOPOROSIS
Saa Milenkovi,Aleksandar Dimi?,Aleksandra Stankovi?,Ivana Aleksi?
Acta Medica Medianae , 2010,
Abstract: The perturbation status of vitamin D can be manifested as insufficiency, deficiency and excessiveness. Vitamin D status within the organism is determined by measuring the level of 25(OH)D in the serum.The aim of this paper was to determine the vitamin D status in postmenopausal women with newly diagnosed osteoporosis as well as to correlate vitamin D status with bone mineral density (BMD) and bones' fractures.The research included 58 postmenopausal women who have recently been given the diagnosis of postmenopausal osteoporosis. All the examinees were determined with the level of 25(OH)D as well as the levels of unspecific markers of the bone metabolism. All of the examinees were defined with their bone mineral density on the lumbar spine and hip, measured with DEXA densitometer.The average age of the examinees was 60,46±6,55 years, average duration of menopause 15,02±9,25 years and average concentration of 25(OH)D 46,45±14,68 nmol/L. Our results has shown the deficiency of vitamin D in 89,76% of the examinees with postmenopausal osteoporosis, positive correlation of the level of 25(OH)D and bone mineral density (BMD) and a significantly lower initial concentration of 25(OH)D with the examines with prior bone fractures opposed to those without fractures (37,57±13,08 vs. 51,22±17,26 nmol/L; p<0,02). The obtained results show that vitamine D deficiency in postmenopausal women with osteporosis present important risk factors for bones fractures as well as factors for decreasing the bone mineral density.
Surgical treatment of pertrochanteric fractures by dynamic methods of external and internal fixation
MilenkoviSaa,Mitkovi? Milorad B.,Radenkovi? Mile,Mladenovi? Desimir
Vojnosanitetski Pregled , 2003, DOI: 10.2298/vsp0306663m
Abstract: Pertrochanteric fractures usually occur in patients over 65 years of age, with greater loss of skeletal mass (osteoporosis). Nonsurgical methods of treatment are accompanied by relatively high lethality rate. Moreover, they do not produce satisfactory anatomical and functional results. Surgical treatment by using dynamic implants represents a method of choice in the fixation of pertrochanteric fractures. This paper presents the treatment results of 110 patients, 61 with pertrochanteric fractures, who were surgically treated by the dynamic method of internal fixation, and 49 patients who were treated by the method of external fixation. Dynamical implants enabled both dynamization and compression of the fracture in the axis of the neck, as well as the diaphysis of the femur, which lowered the risk of mechanical complications, and, at the same time, provided effective healing of the fracture, early activation, and mobilization of the patients on whom the surgery was performed. In patients infected by various diseases, for whom surgical trauma represents a life threat, the external fixation is recommended as a method of choice.
External skeletal fixation of the tibial shaft fractures
MilenkoviSaa,Mitkovi? Milorad B.,Radenkovi? Mile
Vojnosanitetski Pregled , 2005, DOI: 10.2298/vsp0501011m
Abstract: Aim. To present the possibility of a successful use of external skeletal fixation in treating the open and closed tibial shaft fractures with Mitkovi ’s external fixator. Methods. External fixation was used in 115 patients with 118 fresh tibial shaft fractures, 82 males (71.3%) and 33 females (28.7%), average age 43.92 years (16 84). Open tibial shaft fractures were present in 37 (31.36%). All the fractures were treated with Mitkovi ’s external fixator type M 20. Results. The results of external fixation were excellent or good in 94.07% of the cases, and bad in 5.08%. Pin tract infection appeared in 7 (5.93%) patients. In only 3 cases an external fixator was removed and treatment continued with the functional braces. Nonunion occurred in 6 (5.08%) patients, of which 4 were with open fractures (2 Gustilo type IIIB, 1 Gustilo type IIIA, 1 Gustilo type II) and 2 with the segment fractures. Compartment syndrome was observed in 1 (0.85%) patient with closed fracture. Malunion was found in 2 (1.69%) patients. Conclusion. External fixation of tibial shaft fractures is a simple and effective method to enable the safe healing of fractures, early mobilization of the patients, early weight-bearing, as well as early rehabilitation. Fixation of tibial shaft fractures was unilateral with convergent pins orientation, and there was also a possibility of compression and distraction.
Unusual case of successful hand replantation with bad functional outcome: A case report
MilenkoviSaa,Paunkovi? Ljiljana,Vi?nji? Milan,Kova?evi? Predrag
Srpski Arhiv za Celokupno Lekarstvo , 2012, DOI: 10.2298/sarh1204229m
Abstract: Introduction. Traumatic hand amputation is a very severe and rare injury. Replantation and revascularization surgery requires the existence of specialized centres and well-educated teams of microsurgeons. In places where there are no such specialized centres for this kind of surgery, traumatic hand amputation is a major concern and quite a challenge, and a successfully performed replantation is a great accomplishment. Case Outline. We report a case of a successfully survived replanted hand in a 35-year-old male patient with unfortunately bad end result of the treatment. The patient with the amputated left hand (disarticulation) had a surgery 4 hours after injury. The urgent surgical procedure required a debridement, the excision of the first row of the carpal bones, external fixation of the wrist, vascular anastomoses, nerve repair, tenorrhaphy, skin sutures and decompression skin incisions. The successful operation did not have a successful post-operative course due to the patient’s psychiatric problems and lack of rehabilitation at the psychiatric institution where the treatment was continued. Conclusion. Successful surgical performance can unfortunately be ruined due to inadequate further treatment course or the wrong selection for such a demanding surgery. The survival of the amputated hand can be achieved surgically, but achieving refunctioning does not always depend on surgery. It also depends on the very patient, his motivation, rehabilitation, as well as on the proper selection for such a demanding and complex surgical procedure.
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