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Search Results: 1 - 10 of 733 matches for " Stojiljkovi? Predrag "
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Importance of External Fixation in Primary Treatment of War Wounds to the Extremities
Predrag Grubor,Milan Grubor,Ivan Golubovi?,Predrag Stojiljkovi
Acta Facultatis Medicae Naissensis , 2011,
Abstract: A war wound is damage to the body having great kinetic energy, inflicted by firearms,(blast, projectile, burn) and sustained in wartime. It is characterised by massive destruction, primary contamination and modified reactivity of the body. The aim of this retrospective study was to show how to primarily treat the injured extremities, with and without fractures, as well as how to select the method for stabilizing fractured bones.The study involved 2.462 wounded persons. They sustained injuries to the extremities, abdomen, thorax and head, and, having sustained the wounds, they received primary surgical treatment at the Orthopaedics and Traumatology Clinic in Banja Luka in the period between September 15, 1991 and December 1, 1995. Out of the 2.462 wounded subjects, 122 (4.59%) were women, 24 (0.9%) were children and 2.269 (94.15%) were men. The average age of the wounded was 33.73 years. Two hundred sixty-five (10.77%) subjects sustained muscular and cutaneous injuries to the extremities, without bone fractures, and 2.197 (89.23%) wounded persons had broken bone fragments that required stabilisation after the primary surgical treatment. Out of the 2.197 wounded persons with broken bones, 2.043 (92.43%) sustained cumminuted fractures with or without bone defects. In 1.573 (72%) cases, broken bone fragments were primarily stabilized using external fixators, in 531(24%) cases plaster cast and plaster cast in combination with Steinmann pins and Kirschner needles, and in 91(4%) cases we used extension.The most commonly encountered complications with external fixators use were as follows: 86 (5.46%) pin tract infections, 3 (0.19%) pin breakages, 42 (2.66%) fixator reassembly procedures due to inadequate primary placement of the external fixator, 6 (0.38%) iatrogenic vascular lesions inflicted with the drill or pin and 4 (0.25%) iatrogenic nerve lesions.The complexity, specific nature and originality of every war wound require expertise, experience, attention and diligence. Every patient is a separate entity and they require an active attitude throughout the course of treatment. The experiences gained in the last war (working with 28 types of external fixators) and the results obtained give me the right to maintain that the method of choice for primary stabilisation of bone fragments in war wounds is Mitkovi ’s external fixation type M20.
Surgical treatment of tibial nonunion after wounding by high velocity missile and external fixators: A case report
Golubovi? Ivan,Vuka?inovi? Zoran,StojiljkoviPredrag,Golubovi? Zoran
Srpski Arhiv za Celokupno Lekarstvo , 2012, DOI: 10.2298/sarh1208515g
Abstract: Introduction. The missiles of modern firearms can cause severe fractures of the extremity. High velocity missile fractures of the tibia are characterized by massive tissue destruction and primary contamination with polymorphic bacteria. Treatment of these fractures is often complicated by delayed healing, poor position healing, nonhealing and bone tissue infection. Case Outline. We present the management of tibial nonunion after wounding by high velocity missile and primary treatment by external fixation in a 25-year-old patient. The patient was primarily treated with external fixation and reconstructive operations of the soft tissue without union of the fracture. Seven months after injury we placed a compression-distraction external fixator type Mitkovic and started with compression and distraction in the fracture focus after osteotomy of the fibula and autospongioplasty. We recorded satisfactory fracture healing and good functional outcome. Conclusion. Contamination and devitalization of the softtissue envelope increase the risk of infection and nonunion in fractures after wounding by high velocity missile. The use of the compression-distraction external fixator type Mitkovic may be an effective method in nonunions of the tibia after this kind of injury. [Projekat Ministarstva nauke Republike Srbije, br. III 41004]
Treatment of multiple fractures in a patient wounded by aircraft bombing
Golubovi? Zoran,StojiljkoviPredrag,Mitkovi? Milorad,Trenki? Srbobran
Srpski Arhiv za Celokupno Lekarstvo , 2010, DOI: 10.2298/sarh1006362g
Abstract: Introduction Aircraft cluster bombs can cause severe fractures characterized by extensive destruction of affected tissues and organs. Case Outline We present the methods and results of treatment of multiple fractures (left supracondilar humeral fracture, comminuted fracture of the distal right tibia, fracture of right trochanter major without dislocation and fracture of the right second metacarpal bone) in a 24-year old soldier after multiple wounding by a cluster bomb. After short pre-operative preparation a surgical debridement of all wounds was done in general anesthesia and the fractures of the humerus and tibia were stabilized with the Mitkovic-type external fixator after adequate reposition. For the reconstruction of bone defect of the tibia we used the method of bone transport using the Ilizarov external fixator. Conclusion Radical wound debridement, abundant rinsing, leaving the wound open, administration of antibiotics and antitetanus immunization, external fixation and early reconstruction of soft tissue and bone defects are the basic elements of the treatment of serious fractures caused by war injuries and aimed at saving the extremities. .
Open segmental fractures of the tibia treated by external fixation
Golubovi? Ivan,Vuka?inovi? Zoran,StojiljkoviPredrag,Golubovi? Zoran
Srpski Arhiv za Celokupno Lekarstvo , 2012, DOI: 10.2298/sarh1212732g
Abstract: Introduction. Open segmental fractures of the tibia are rare but severe injuries. In these fractures the wide zone of injury (damage of all structures of the lower leg) creates very unsuitable biological conditions for healing of the fracture. Objective. The aim of our work was to present the results of treatment of patients with segmental open fractures of the tibia treated by external fixation. Methods. We analyzed treatment results of 21 patients with open segmental tibial fractures who were treated using the method of external fixation at the Clinical Center Ni from January 1, 1995 to July 31, 2010. The average age of the patients was 53 years; the youngest patient was 27 years and the oldest one 80 years. According to the Gustilo open fracture classification, there were 3 (14.3%) type I, 6 (28.6%) type II, 8 (38.1%) type IIIA, and 4 (19.0%) type IIIB. All the patients were treated by a unilateral type Mitkovi external fixator by Traffix Company. Results. Union was attained in 16 (76.2%) fractures without severe complications (pseudoarthrosis, chronic osteitis and angular deformities of over 10 degrees). Among severe complications associated with open segmental tibial fractures, in two cases we registered septic pseudoarthrosis, in one aseptic pseudoarthrosis and in two large angular deformities of the tibia after union, with a valgus of over 10 degrees and extremity shortening of over 2 cm which required additional surgery. Conclusion. External fixation by the use of Mitkovi external fixator is one of the methods of choice in the treatment of open segmental tibial fractures, which incorporated with antibiotic therapy provides good biomehanical conditions for segmental fracture healing that enables good stability of the segmental tibial fracture and decreases the risk of deep infections. [Projekat Ministarstva nauke Republike Srbije, br. 41017: Virtuelni ko tano-zglobni sistem oveka i njegova primena u pretklini koj i klini koj praksi]
The prevention of pancreatico-jejunostomy leakage
Stojanovi? Miroslav P.,Jeremi? Miroslav,Stojanovi? Predrag,Stojiljkovi? Miroslav D.
Acta Chirurgica Iugoslavica , 2002, DOI: 10.2298/aci0201039s
Abstract: The aim of this study was to test the protective effects of fibrin sealing on the pancreatico-jejunostomy (PJA), the high-risk anastomosis following pancreas head resection. Experimental study was performed on the mongrel dogs, divided in two groups (20 animals each): Experimental group - with end to end "dunking" PJA, protected by temporary occlusion of the pancreatic duct with fibrin sealant /Tissucol/Immuno Ag/, while control group was without any protective procedure. The animals were followed 5 months in order to study: protective effects of such procedure on the PJA quantified with the percent of anastomotic leakage, effects of the exocrine secretion and effects the endocrine function Results: PJA leakage occurred in 13.33% in control group. No leakage was registered in experimental group. Biochemical, histological and electron microscopic study showed slight transitory elevation of amylase levels. Fibrin glue plug was dissolved and pancreatic juice output was reestablished 12th days postoperatively. Long term follow-up showed no damages of the endocrine and exocrine pancreas. Pancreatic duct occlusion with fibrin glue appeared to be an useful method in the prevention of pancreatico-jejunostomy leakage, without negative effects on the exocrine and endocrine pancreas.
Predrag Stojiljkovi,Zoran Golubovi?,Desimir Mladenovi?,Ivan Mici?
Acta Facultatis Medicae Naissensis , 2009,
Abstract: Polytrauma is the leading cause of death in adults up to the age of 50 years. Proper management of closed femoral shaft fractures in polytrauma patients can greatly reduce mortality and morbidity. The prospective study followed and analyzed 68 polytrauma patients with 70 closed femoral shaft fractures, who were operatively treated in the Clinical Center Ni from June 1, 1999 to June 1, 2006. Worsening of the overall patients' condition following the external and internal fixation of the fractures pointed to statistically significant difference (χ2=16.40 p<0.001). Exacerbation of the condition of the polytrauma patients with femoral fractures was more frequently documented after internal fixation within initial 24 hours. External fixation of the fracture was followed by longer period of fracture healing, worse functional outcome and more frequent complications related to fracture management compared to the applied methods of internal fixation. The obtained results confirm the hypothesis that early internal fixation of the femoral fractures in the polytrauma patients poses great and additional trauma for the injured, and it can be safely performed after stabilizing the patient condition. External fixation stands for a safe operative method for accomplishing temporary stability of the femoral fracture in the polytraumatized patients and a minimally additional operative trauma. However, it is associated with a number of complications and a worse functional outcome when compared to the internal fixation method. External fixation of the femoral fracture in the polytraumatized patients should be converted into internal fixation when the patient's condition allows.
Lower Leg Severe Open Fracture Caused by Traffic Accident - Treatment by External Skeletal Fixation: Case Report
Ivan Golubovi?,Goran Stevanovi?,Predrag Stojiljkovi,Zoran Golubovi?
Acta Facultatis Medicae Naissensis , 2012,
Abstract: 72 years-old woman suffered an open fracture of the right tibia, as a pedestrian, when the bus tires crossed over the right foot. She was immediately transported to the Clinical Center Ni and following clinical examination, the amputation of the lower leg was advised due to extensive injury. On admission to the hospital (Clinic for Orthopedics and Traumatology), after resuscitation, arteriography of the blood vessels of the right leg was performed. Spasm of blood vessels of the right leg below the fracture was noted, but the circulation in the distal part of the lower leg and foot was preserved. After removing temporary immobilization and bandage of the lower leg, a large wound was noticed, from the toes to the popliteal crease. Primary treatment of the wound was done and tibial fracture was stabilized with external fixation (with convergent orientation of the pins). Almost the whole wound was left open, while the vital structures of the leg (the main blood vessels and nerves) were covered with local soft tissues that are adapted by situation sutures. Due to the large soft tissue destruction on the right lower leg and diabetic angiopathy, the patient was sent to special orthopedic hospital "Banjica" in Belgrade. After repeated wound debridements, external skeletal fixator was removed and the Ilizarov apparatus was placed. Soft tissue defect was covered by skin graft. In the postoperative period, patient was regularly dressed. Eight months later, the fractured tibia healed and the Ilizarov apparatus was removed. The patient was referred for rehabilitation. Following rehabilitation, patient returned to her work and everyday activities.
External Fixation in the Management of Closed Segmental Tibial Fractures
Zoran Golubovi?,Predrag Stojiljkovi,Ivan Golubovi?,Zoran Radovanovi?
Acta Facultatis Medicae Naissensis , 2013, DOI: 10.2478/v10283-012-0034-2
Abstract: Segmental fractures represent the interruption of bone integrity at two or more levels. In these fractures, a wide zone of injury (damage of all structures of the lower leg) creates very unsuitable biological conditions for healing of the fracture. Because of the damage of both intramedullary and periostal vascularization, segmental fractures are predisposed to slow healing and development of pseudoarthrosis.The aim of the paper was to present the results of treatment of patients with closed segmental tibial fractures treated by external fixation.Within the period between January 1, 1998 and June 31, 2012 in the Clinical Center Ni , 26 patients with closed segmental fractures of the tibia were treated. The assessment of outcomes of treatment of closed segmental tibial fractures by external fixation was performed on a series of 24 patients. The mean age was 43.57 years. All the patients were treated by Mitkovi unilateral external fixator produced by “Trafix” firm. Fracture healing occurred in 20 (83.33%) patients; four (16.67%) patients reported significant complications in the course of treatment that required further surgical treatment. By applying the method of external fixation in the treatment of closed segmental tibial fractures, reposition of fragments is achieved through a small incision, with pins of exteranal fixator placed outside the fracture zone to prevent further damage of intramedullary and periosteal bone vascularisation, which is very important for fracture healing.
Desimir Mladenovi?,Milorad Mitkovi?,Sa?a Karalai?,Predrag Stojiljkovi
Acta Medica Medianae , 2010,
Abstract: Osteogenesis is the process of bone tissue forming, i.e. bone or callus regeneration. This process is influenced by many factors, and the degree of bone fragments’ stability and vascularization in the fracture area are the basic local factors which determine the nature of reparative process. Regenerative process of all bone structures increases with increasing of blood supply.The distal lower leg has its specific biomechanical features, and plays an important role in the transfer of body weight to foot. The distal part of tibia has a small diameter, which as a consequence has reduced diameter in medullar cave. Through this anatomic feature, the medullar network in the lower tibia part is also reduced.As for anatomic aspect, vascularization in the lower end of tibia is poor. It primarily depends on periosteal vascularization, because medullar vascularization is reduced. Fasciae, tendons and skin cover the lower part of the leg, and there is no muscle mass. These tissues have poor vascular network and that is why the extraosseous blood circulation in tibia is poor, and does not participate in the osteogenesis process. For these reasons, distal lower leg represents a predelection site for delayed osteogenesis and pseudoarthrosys development.Osteosynthesis causes secondary damage to bone and soft tissue circulation. The screw plate damages the periosteal circulation – in the lower part of tibia it is the main source of vascularization, and for this reason, this method of osteosynthesis should not be applied. The external fixator has a sparing role regarding vascularization, and that is the reason why this method is recommended for fracture stabilization at the level of distal lower leg.
Ivan Golubovi?,Predrag Stojiljkovi,Zoran Golubovi?,Goran Stevanovi?
Acta Medica Medianae , 2011,
Abstract: Polytrauma represents the most difficult form of trauma epidemic. Appropriate treatment of the femoral shaft fracture in polytrauma patients can significantly reduce mortality and morbidity. External skeletal fixation in patients with femoral shaft fracture presents a minor surgical trauma with minimal blood loss. In modern trauma centres, external skeletal fixation in polytrauma patients is a temporary method (as a part of damage control“strategy) where immediate extensive internal fixation could be risky. It is usually postponed until the patient status is stable with normal vital parameters.This paper presents a polytrauma patient with dominant abdominal injury and femoral shaft fracture. During the same operation, external skeletal fixation was applied after abdominal surgery was done. Conversion of external into internal fixation was carried out because of postoperative febrile state that lasted for 14 days. External skeletal fixation was a definitive method of treatment. Fracture of the femoral shaft healed after 7 months with good functional outcome.External skeletal fixation is a successful method of treatment for femoral shaft fracture in polytrauma patients. It is a temporary method as a part of damage control“ strategy and is usually followed by internal fixation. Sometimes, it is a definitive treatment method in patients with open and comminuted fractures of the femoral shaft and in polytrauma patients when the above mentioned conversion is not safe.
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