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Open access

Şerban Al. O. and Obadâ B.

Abstract

The purpose of this study was to compare the outcomes and complications of locking or nonlocking clavicular hook plate for fixation of unstable lateral clavicle fractures. All patients with unstable Neer type II lateral clavicle fractures were operated in our hospital from January 2011 to December 2012. The included participants received either locking or nonlocking clavicular hook plate operations. Demographic data, medical records and radiographs were reviewed retrospectively. At the last follow-up, shoulder function was evaluated with Constant-Murley scoring system. Our findings suggest that locking clavicular hook plates are equally useful for treating unstable lateral clavicular fractures, but in face of complicated ones, the locking hook plate would not get more benefits than nonlocking hook plate.

Open access

Obada B. and Serban Al. O.

Abstract

The aim of the study is to evaluate the surgical treatment comparing the results obtained with different techniques. We revised 68 cases with acute Achilles tendon rupture who underwent surgical correction between 2004 and 2011, with a 40 month average follow-up. 34 of these were submitted to a classical open repair using the Kessler or Krakow technique, 25 to a mini-invasive technique (Achilon) and 9 to a percutaneous technique (Tenolig). We report a 29% rate of complications when using the classical technique: the major complications were one re-rupture, two surgical wound dehiscences, one infection and one sural nerve injury. In the mini-invasive/percutaneous techniques, two re-ruptures occurred (5.9% total, one in each technique) and one fistula at the needle insertion location. In regards to the percutaneous and mini-invasive techniques, the functional results and degree of satisfaction were higher, with fewer complications, reflecting a trend that has been expressed in the international literature.

Open access

B. Obada, Al. O. Serban and R. Turcu

Abstract

The ankle stability and its biomechanics can be compromised after ligamentous and malleolus lesions. The complete early diagnosis, and also the early and late postsurgery results, must be formulated and explained using the tibio-astragalus radiologic indices. The paper evaluates the importance of these presurgery and postsurgery indices, analyzing also the late results under causal report. Our subordinating to the exigency of radiologic indices to obtain a reparation as anatomic as possible, shows that the surgical treatment must be applied to osteo-ligamentous lesions properly, so that to get the remake of tibio-astragalus biomechanics.

Open access

Al. Șerban, V. Botnaru, R., Turcu, B. Obadă and St. Anderlik

Abstract

Background: The gold standard treatment for complex fractures of tibial shaft is the reamed interlocking intramedullary nail. There has been some controversies about dynamization of statically locked nail, and some authors recommend routine dynamization for promotion of healing. This study evaluates the treatment of complex fractures of tibia shaft with static and dynamic interlocking intramedullary nail method.

Methods: In this retrospective study, we studied 100 patients treated in Clinical Emergency Hospital Constanta between April 2012 - July 2013 diagnosed with tibia and fibula shaft fractures. They were treated by external fixation, and intramedullary nail. The intramedullary nail was blocked distally static or dynamic.

Results: All patients achieved union during 12-18 weeks. The need of dynamization was required at 23 patients after 10 weeks from osteosynthesis.

No significant complication was observed in our patients. Alignment of tibial fracture was perfect in all patients without any shortening and rotation.

Conclusion: Locked intramedullary nailing is the treatment of choice for fractures of the tibial shaft.

Open access

B. Obada, Mădălina Iliescu, Al. O. Serban, Camelia Tecu and Anca Nicolau

Abstract

The aim of the study was to determine prospectively the importance of synovial fluid white cell count and intraoperative frozen and permanent sections analysis (number of polymorphonuclear leukocytes per high-power field) in the diagnosis of septic total knee arthroplasty. There were studied prospectively 72 patients who needed a revision total knee arthroplasty between 2013-2015. 30 patients were diagnosed with prosthetic joint infection due to high rates of ESR (93%) and CRP (90%) and preoperative positive culture from aspirated synovial fluid and 42 patients were considered to have aseptic failure according to negative preoperative culture from joint aspirate. For all the patients was analysed synovial fluid white cell count and histopathological aspect of intraoperative frozen and permanent sections of periprosthetic tissue. The results showed a median value of 13800 of sinovial white cells count for infected knee and 92 for noninfected knee. 90% of the patients with joint infection had more than 5 polymorphonuclear leukocytes per high power field on intraoperative frozen sections and 83% on permanent sections. None of the patients from aseptic group had more than 5 polymorphonuclear leukocytes per field on permanent sections. The erythrocyte sedimentation rate and C-reactive protein level can be supplemented with cultures of aspirated joint fluid and fluid white cell count to confirm the diagnosis of periprosthetic infection. When the preoperative diagnosis remain unclear, the histological examination of frozen or permanent sections of periprosthetic tissue with at least 5 polymorphonuclear leukocytes per high power field, is predictive for the presence of infection.

Open access

V. Botnaru, Al. O. Șerban, Al. Valcu and B. Obadă

Abstract

A retrospective study on 2 years and 4 months (April 2012 - August 2014) on 430 patients admitted with trochanteric fractures in our Clinic. The surgical indications depended on the patients age, degree of osteoporosis, level activity, associated pathologies and the anatomo-clinical particularity of the fractures. The fractures were operated with gamma nail. The surgery was done in the first 24-72 hours, patients were followed clinically and radiographically at 2, 4, 6 months postoperative. The age of the patients were between 28-95 years, female sex was predominant in 65% of case. It was reported a case of a fracture produced intraoperatory during progression of the nail, 11 bronhopulmonary complications, 5 phlebitis, 7 cases of hematoma after surgery, a case of pseudarthrosis with loosening of implant and 4 dead. There were no septic complications. Fractures consolidate within 12- 14 weeks. The results were appreciated according to fracture reduction, stability of implant, consolidation time and possibility of walking and weight bearing on operated limb.

Open access

B. Obadă, Al. O. Șerban, V. Botnaru and Al. Valcu

Abstract

Diagnosis of hip fractures is particularly important due to the high dependence on the integrity of this structure for people to function in their daily lives. Left unrecognized, patients face increasing morbidity and mortality as time from the original injury lengthens. A delay of just 2 days in surgical treatment for an acute hip fracture doubles mortality. In addition, an unrecognized non-displaced fracture may displace, requiring surgery of much higher risk. This may be part of the reason that the most frequent lawsuit against Emergency Physicians is for missed orthopedic injury. We reviewed the use of MRI and CT for occult hip fractures (OHF) detection at a major urban trauma unit. Our study is a retrospective review. Inclusion criteria: all patients presenting to the Emergency Clinical Hospital of Constanta with a suspected, posttraumatic, occult hip fracture, over a 5 years period were included. All patients had negative initial radiographs and underwent further imaging with either CT or MRI. A total of 185 cases meeting the inclusion criteria were identified. 72 occult hip fractures were detected with both imaging modalities. Although MRI certainly enables greater image detail, in our experience both modalities are able to provide satisfactory fracture characterization. The choice of imaging should be determined by availability and indication. MRI provides superior imaging of soft tissue but is less sensitive for degenerative changes in presence of bone edema.

Open access

Al. O. Șerban, B. Obadă, V. Botnaru and Al. Valcu

Abstract

Through the evaluation of some etiopathogenic risk factors one can anticipate the evaluation of some fractures towards Compartmental Syndrome (CS) and then their diagnosis in early stage, when the symptomatology is still unconvincing and the treatment reduces the risk of ischemia lesions. Based both on some prospective observations, using a group of shank fractures, and also on the clinical facts of constituted CS, there were made correlations, statistically reported in the case of some etiopathogenic risk factors represented by the fracture localization and its characteristics, traumatic mechanisms, soft tissue quality and polytraumatism, having an objective common denominator, the compartmental pressure level measured directly. The authors propose an etiopathogenic risk score of CS for the fractures reaching the pressure level of 20-30mmHg, recommending the pressional and clinical monitoring for a score of minimum 10 points. These fractures have a certain risk of CS.

Open access

Al. O. Serban, B. Obada, Georgiana Radu and M. Zekra

Abstract

The prospective study targets the tibial pylon fractures admitted in our clinic, to which a new treatment protocol was applied, consisting of two surgical steps, assessing in the end the results achieved at the discharge of the patient and later follows up. The study group consist of 196 patients (198 fractures), in the period 2012-2015.

The average evaluation time was of 16 months. The average age of the patients was 46.5 years (19-83 years), this type of fracture especially affecting active people. The etiology was dominated by high falls (109 cases), most of them being work related accidents. The most frequently applied osteosynthesis principle was staged osteosynthesis which consisted of first stage fibula semitubular plate osteosynthesis and external fixator tibia pylon, followed by minimally invasive or limited approach locked plate tibia pylon fixation. (64.14%) Olerud and Molander clinical score at more than one year after the last surgical intervention highlights good results: excellent results in the amount of 37% to 15% in the first lot, good results 52% to 29%, moderate success 7% to 39% and poor 4% to 17%.

Two stage surgery protocol with external fixation in emergency and minimally invasive internal fixation with locked plate performed after the dissappearance of the local edema, as the second surgical step, allows anatomically correct articular reconstruction without skin complications, with decrease of arthitic late complications.

Open access

B. Obada, Madalina Iliescu, Al O. Serban, Crina Alecu-Silvana and M. Zekra

Abstract

The study was aimed to identify the role of surgical treatment of tibial plateau fractures, its functional outcome and complications. Demographic data for the patients and details of current clinical and radiological follow-up findings were obtained to assess range of motion, clinical stability, alignment of the knee, and posttraumatic arthrosis (Kellgren/Lawrence score). 64 cases of tibial plateau fractures treated by different surgical methods and variuos implants type were studied from 2013 to 2015 and followed-up for minimum period of 6 months. The systematisation of the casuitry was made using Schatzker and AO classifications. The treatment methods consist of: percutaneous cannulated cancellous screws, ORIF with buttress plate with or without bone grafting, locking or nonlocking plates, external fixator. As complications we found: redepression 4 case, malunion 2 cases, knee stiffness 9, wound dehiscence in 1 cases and non-union or infection in none of our cases. The average flexion of the injured knee was significantly lower in comparison with the contralateral side (124.9°/135.2°). Knee stability did not differ statistically significantly. There were no signs of posttraumatic arthrosis in 45% of cases, mild signs in 30%, clear signs in 18%, and severe signs in 7%. As conclusion we found that surgical management of tibial plateau fractures will give excellent anatomical reduction and rigid fixation to restore articular congruity, facilitate early motion and reduce arthrosis risk and hence to achieve optimal knee function. The choice of optimal surgical methods, proper approach and implant is made in relation to fracture type according Schatzker and AO classification.