Papers by Zdravko Jotanovic
Four-part fractures in elderly patients are often treated by shoulder arthroplasty. Depending on ... more Four-part fractures in elderly patients are often treated by shoulder arthroplasty. Depending on the status of the greater tuberosity, anatomical or reverse shoulder prosthesis can be used. If the anatomical prosthesis is used, the greater tuberosity must be fixed to the implant or to the humeral shaft in order to enable normal function of the rotator cuff. Non-healing of the greater tuberosity will signify failed function of the shoulder.
Periodicum Biologorum, 2015
Osteoarthritis, as the most common form of arthritis, affects predomi nantly middle-aged and elde... more Osteoarthritis, as the most common form of arthritis, affects predomi nantly middle-aged and elderly population worldwide. This chronic, degen erative, progressive and multifactorial joint disease can affect different joints in the body. One of the most commonly affected joints with osteoarthritis is the hip joint. Hip osteoarthritis is characterized by the presence of pain, stiff ness, and limping which ultimately results with inability to perform activities of daily living. Thus, hip osteoarthritis significantly affects patients’ quality of
Aim: We studied genetic epidemiology of primary large-joint (hip and knee) osteoarthritis (OA), i... more Aim: We studied genetic epidemiology of primary large-joint (hip and knee) osteoarthritis (OA), in order to find disease risk factors by a candidate-g
TO THE EDITOR Arthroscopic shoulder stabilization is a widely accepted method. Very often, an art... more TO THE EDITOR Arthroscopic shoulder stabilization is a widely accepted method. Very often, an arthroscopic treatment is preferred by patients and surgeons because it is minimally invasive, spares the subscapularis muscle, and because it enables better identification and treatment of associated pathological conditions, and decreases morbidity. Furthermore, recent studies have demonstrated that the results of arthroscopic treatment of recurrent traumatic anterior instability are comparable with those achieved historically with open procedures 1-3. However, arthroscopy is not always effective and there are cases which require open surgical techniques. There is a variety of reports regarding recurrence rates after arthroscopic Bankart repair, depending on arthroscopic skill, but also on the severity of the instability 4. Therefore, the patient selection plays an important role on the success rate. After the first traumatic dislocation, a closed reduction has to be done, and the shoulder is put in the sling for two weeks. This rule is indicated for the general population, but if we treat top athletes, sometimes an immediate arthroscopy is indicated. After the period of rehabilitation, some shoulders will remain unstable, and the dislocation can occur during swimming, jumping or even during sleeping. The redislocation rate in the general population is around 50 % 5. In younger patients or those with hyperlaxity, the percentage is higher, even up to 80 % or 92 % 6-9. In Germany, in 73 % of hospitals surgery will be indicated for active younger patients under 30 10,11. In case of recurrent instability, surgical therapy must be considered. For young patients with 2-6 redislocations after traumatic dislocation, arthroscopic treatment is indicated. The lesion of the anterior labrum is called the Bankart lesion and has several forms. There are several arthroscopic techniques, which include placement of titanium or resorbable implants into the anterior glenoid rim, and labrum repair is performed (Figure 1). In decision making regarding the selection of the surgical technique, we try to perform an anatomical repair, either open or arthroscopic. Therefore, the glenoid labrum repair together with capsular shift is generally accepted as the "gold standard". In patient selection, the first step is a careful clinical
Medicina Fluminensis, 2020
Cilj: Cilj rada bio je prikazati da i manje traume u adolescentno doba mogu uzrokovati avulziju t... more Cilj: Cilj rada bio je prikazati da i manje traume u adolescentno doba mogu uzrokovati avulziju tuberositasa tibije te ukazati na mogućnost nastanka kompartment sindroma. Prikaz slučaja: Kod dječaka u dobi od 15 godina pri promjeni smjera kretanja došlo je do avulzije tuberositasa tibije. Ozljeda je popraćena velikim edemom. Nakon operacije razvila se pareza peronealnog živca koja je uz medikamentoznu i fizikalnu terapiju regredirala u cijelosti. Zaključak: Pri sumjnji na avulziju tuberositasa tibije potrebna je žurna dijagnostika i liječenje. Zbog mogućeg nastanka sindroma kompartmenta potreban je pojačan nadzor u perioperacijskom periodu.
HIP International, 2020
Background:The modern indications for Chiari pelvic osteotomy (CPO) have narrowed and the number ... more Background:The modern indications for Chiari pelvic osteotomy (CPO) have narrowed and the number of such operations performed has diminished markedly. So far published long-term experience with CPO indicate the fact that in selected patients satisfactory functional results can be achieved. The aim of this study was to investigate the parameters which influence CPO survival and its conversion into total hip arthroplasty (THA).Methods:This is a single-centre retrospective case-series study. In the period from 1976 to 2012, it included 172 CPO in 158 patients. Of those, in 43 patients (48 hips) the follow-up was discontinued, leaving 115 patients (124 hips) for final analyses. The median age at the time of the surgery was 34 years, and the mean duration of the follow-up was 19 years.Results:In 115 patients (124 CPO) included in the study, a total of 51 THA was performed in 49 patients. The median period between CPO and THA was 14 years.Conclusion:Supporting our results, we suggest that...
Journal of Orthopaedic Research, 2017
ABSTRACTPrimary osteoarthritis (OA) is the most common type of a joint disease. It has a polygeni... more ABSTRACTPrimary osteoarthritis (OA) is the most common type of a joint disease. It has a polygenic risk inheritance pattern and affects older people. The etiology of this disease is not fully understood. The aim of this study was to investigate the associations between polymorphisms in pro‐inflammatory interleukin‐17 (IL17A and IL17F) and anti‐inflammatory Toll‐like Receptor 10 (TLR10) genes with the risk for development of advanced stage hip and knee primary OA in the Croatian population. A total of 500 OA patients and 597 controls were genotyped for IL17A SNP (rs2275913), IL17F SNPs (rs763780 and rs1889570), and TLR10 (rs11096957) genes. The allelic and genotypic frequencies of IL17F SNP (rs763780) showed statistically significant differences in comparisons of controls with hip—but not knee—OA patients. The major allele (T) of rs763780 was associated with the lower risk for developing hip OA (p = 7.9 × 10−4, OR = 0.45, 95%CI = 0.27–0.74), whereas the minor allele (C) was associate...
Journal of Orthopaedic Research, 2019
ABSTRACTWe studied the genetic epidemiology of primary large‐joint (hip and knee) osteoarthritis ... more ABSTRACTWe studied the genetic epidemiology of primary large‐joint (hip and knee) osteoarthritis (OA), in order to find disease risk factors by a candidate‐gene approach. We used case–control study in the Croatian Caucasian population. We genotyped 500 OA patients (260 hip, 240 knee; both with total joint replacements) and 597 healthy individuals for single‐nucleotide polymorphisms (SNPs) in interleukin 17A (IL17A) (rs2275913) and IL17F (rs763780 and rs1889570) genes. On the basis of our population and allelic and genotypic frequencies haplotypes were predicted by PHASE software and compared between patients and controls. The three‐SNP haplotype (rs2275913–rs763780–rs1889570) G–C–A confers predisposition to hip (p < 0.005) but not knee OA. The three‐SNP haplotype having opposed nucleotides A–T–G was found significantly associated with 2.6 times higher risk for developing knee (p < 0.02) but not hip OA. The haplotype G–T (IL17A–IL17F; rs2275913–rs763780) is associated with prot...
Foot & Ankle Specialist, 2017
Purpose: The purpose of the study was to determine whether lateral soft-tissue release (LSTR) has... more Purpose: The purpose of the study was to determine whether lateral soft-tissue release (LSTR) has a beneficial or detrimental effect on the outcome of distal Chevron first metatarsal osteotomy (DCMO) in the treatment of moderate hallux valgus (HV). Methods: We compared the effect of different surgical treatments in 2 groups of patients: group I (23 patients, 25 feet, average age of 55 [from 43 to 77] years) was subjected to DCMO only, whereas group II (18 patients, 23 feet, average age of 59 [from 52 to 70] years]) was subjected to DCMO with LSTR. The American Orthopaedic Foot and Ankle Society’s Hallux Metatarsophalangeal-Interphalangeal scale survey was conducted postoperatively, followed by the brief survey on postoperative patient satisfaction. The patient follow-up period was from 18 to 24 months after surgical treatment, on average. Results: After surgical intervention, both groups of patients presented with an improved HV angle, but there was no significant difference between...
Medicina Fluminensis, Mar 2, 2015
In the past 60 years, primary THA has been one of the most successful and most performed orthopae... more In the past 60 years, primary THA has been one of the most successful and most performed orthopaedic procedure. Over the years, hip arthroplasty has changed, and research continues to improve its results. Better materials and design provide patients with an increased range of motion with enhanced stability and very low wear. In recent years, there have been a number of reports describing the performance of THA through smaller incisions using minimally invasive surgical techniques, aimed to spare the soft tissue, especially the abductor musculature. These techniques allow less post-operative pain, reduced blood loss, shorter hospitalization, better functional recovery and faster return to everyday routine. However, tissue sparing techniques can result in numerous complications related to the learning curve. Today four minimally invasive approaches have been described and many of their modifications. All of them are technically demanding, and may require specialized instruments and equipments. This article describes in detail the surgical technique of a minimally invasive anterolateral hip approach with patients in the supine position, including the preoperative setting, with pearls and tips based on the authors' experience.
Collegium antropologicum, 2009
Open total dislocation of a talus with extrusion (missing talus) is an extremely rare injury. We ... more Open total dislocation of a talus with extrusion (missing talus) is an extremely rare injury. We present a case of a 63-year-old male who sustained an open total lateral dislocation of the right talus with extrusion and without a concomitant fracture after a fall from a small height. Tibiocalcaneonavicular arthrodesis was performed. Arthrodesis failed, and due to painful and unstable ankle, rearthrodesis was performed two years later, successefully. Because of rarity of this kind of injury, hers importance for foot function, previously described various treatment options and absence of guidelines, herewith we propose, according to our experience and review of literature, the algorithm for the treatment of this rare injury.
Collegium antropologicum, 2013
Chronic recurrent multifocal osteomyelitis (CRMO) is an extremely rare and most severe form of ch... more Chronic recurrent multifocal osteomyelitis (CRMO) is an extremely rare and most severe form of chronic nonbacterial osteomyelitis of unknown etiology. Here we present the first case of a six-year-old girl in which was observed that the stress fracture mimic osteomyelitic foci in the course of CRMO.
Collegium antropologicum, 2012
Treatment of infected tibial nonunion with bone defect represents a challenge for every orthopaed... more Treatment of infected tibial nonunion with bone defect represents a challenge for every orthopaedic surgeon. Various methods of treatment have been described for nonunions with infection, bone loss or both. One of them is the central bone grafting technique, which is a safe and effective treatment for nonunions of the tibia. The technique involves placement of autogenous cancellous bone from the iliac crest on the anterior surface of the interosseous membrane with the aim of creating a tibiofibular synostosis. We present the results of uncontrolled, retrospective and continuous series of ten patients treated by a central bone grafting technique for infected tibial nonunion with bone loss. Mean follow-up period was 12 (10-15) years. Most injuries were a result of war injuries. Clinically and radiologically confirmed bony healing with total consolidation of the graft was achieved in all patients within a period of 10-12 months without further bone grafting. The newly-formed bone mass ...
Collegium antropologicum, 2011
Trochanteric femoral fractures are a major problem in the elderly because of higher bone fragilit... more Trochanteric femoral fractures are a major problem in the elderly because of higher bone fragility due to osteoporosis. Numerous chronic illnesses, which usually affect the elderly, aggravate and complicate their surgical treatment. Trochanteric femoral fractures results in high morbidity and mortality in elderly patients. The aim of our study is to evaluate the effectiveness of hemiarthroplasty in the treatment of unstable trochanteric femoral fractures in elderly patients. Between 2000 and 2005, 50 patients with unstable trochanteric femoral fractures (41 women) aged 75 to 92 years (mean 86 years) underwent cemented hemiarthroplasty. The surgical procedure was performed within first 48 hours after the fracture (out of which 14 in the first 12 hours, 27 in the first 24 hours and 9 in the first 48 hours), with minimal blood loss. Hemiarthroplasty was indicated in patients where stability was important to allow early mobilization. In forty patients (80%) early ambulation with full we...
Sažetak. Subtalarna artroereza vrijedna je metoda u liječenju simptomatskog fleksibilno spuštenog... more Sažetak. Subtalarna artroereza vrijedna je metoda u liječenju simptomatskog fleksibilno spuštenog stopala dječje dobi te vrijedna pomoćna metoda u liječenju simptomatskog fleksibilno spuštenog stopala odrasle dobi, kod kojih intenzivna konzervativna terapija nije polučila rezultate uklanjanja bola. U literaturi ima nedovoljno podataka o dugoročnom postoperativnom praćenju bolesnika i dugotrajnom učinku artroereze na oboljela stopala u dječjoj i odrasloj dobi te njenom utjecaju na ostatak muskuloskeletnog sustava.
Breast cancer has a complex genetic susceptibility. Innate and adaptive immunity can additionally... more Breast cancer has a complex genetic susceptibility. Innate and adaptive immunity can additionally increase the genetic risk to breast cancer development. We typed polymorphisms in the genes of the interleukin(IL)-1 and IL-17 proinflammatory cytokines in a case-control study in Caucasian population from Croatia. We compared the allelic and genotypic frequencies between patients (n=194), healthy women (n=188) and general population (n=531). The risk for breast cancer has been significantly different at both allelic and genotypic levels for two polymorphisms: the IL1B gene single nucleotide polymorphism (SNP) at-511 (G>A; rs16944) and the IL1 Receptor antagonist gene (IL1RN) variable number of tandem repeats (VNTR). The major allele (G) of the IL1B rs16944 SNP was associated with susceptibility to breast cancer (P<0.01) in general population with odds ratio (OR) of 1.42 and 95 % confidence interval (CI) at 1.09-1.85. The IL1RN VNTR allele 3 (5 repeats) was correlated with predisposition to disease
Journal of Orthopaedic Research, 2014
Family with sequence similarity 46, member A (FAM46A) gene VNTR and BCL2-Associated Athanogene 6 ... more Family with sequence similarity 46, member A (FAM46A) gene VNTR and BCL2-Associated Athanogene 6 (BAG6) gene rs3117582 polymorphisms were genotyped in a case-control study with 474 large-joint (hip and knee) osteoarthritis (OA) patients and 568 controls in Croatian population by candidate-gene approach for association with OA. We found that BAG6 rs3117582 SNP genotypes were associated with protection (major allele homozygote) and susceptibility (major-minor allele heterozygote) to OA. BAG6 rs3117582 major allele (A) was associated with reduced risk to OA while the minor allele (C) was associated with increased risk to OA. We identified 6 alleles harboring 2 to 7 repeats making 20 genotypes for FAM46A. A rare FAM46A VNTR genotype comprising VNTR alleles with four and seven repeats (c/f) was associated with increased OA risk in both genders. The genotype with four and six repeats (c/e) was also associated with increased risk to OA in males. A polymorphic FAM46A allele with six repeats (e) was associated with reduced risk to OA in females. Our results suggest association between the FAM46A gene, BAG6 gene and OA in Croatian population, respectively. This is the first study to show associations between these genetic loci and OA.
Wiener klinische Wochenschrift, 2010
Osteomyelitis is an inflammation of the bone caused by infecting organisms. We present here the f... more Osteomyelitis is an inflammation of the bone caused by infecting organisms. We present here the first case of osteomyelitis of the distal femur caused by Salmonella typhimurium in a patient with Crohn&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease. The infection was successfully treated with a combination of antibiotics and surgical treatment.
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Papers by Zdravko Jotanovic