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Chronic osteomyelitis in Sarajevo, Bosnia-Herzegovina: Long-term health consequences of warfare

January 10, 2019/in Jan. - April 2019 | Volume 5 | Issue 1

Vol 5 | Issue 1 | Jan-April 2019 | page:14 -16 |Katherine O. Ryken, Semin Becirbegovic, Ismet Gavrankopetanovic, J Lawrence Marsh, Marin Schweizer. Author: Katherine O. Ryken [1], Semin Becirbegovic [2], Ismet Gavrankopetanovic [2], J Lawrence Marsh [1], Marin Schweizer [1] 1 Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA 2 […]

A Rare and Atypical Case Report of Combined Rupture of Patellar Tendon, Anterior Cruciate Ligament, Medial Collateral ligament, and Lateral Meniscus Managed Operatively

September 10, 2018/in Volume 4 | Issue 2 | Sep-Dec 2018

Vol 4 | Issue 2 | Sept-Dec 2018 | page: 17-19 | Naveen Mittal, Robin Bohat, Ankush Jindal, Akash Singhal. doi- 10.13107/ti.2018.v04i02.071 Author: Naveen Mittal [1], Robin Bohat [1], Ankush Jindal [1], Akash Singhal [1]. [1] Department of Orthopaedics, Government Medical College Hospital Chandigarh. Address of Correspondence Dr. Naveen Mittal, #3732 Sector 46C, Chandigarh, India. Email: […]

Chronic osteomyelitis in Sarajevo, Bosnia-Herzegovina: Long-term health consequences of warfare

January 10, 2019/in Jan. - April 2019 | Volume 5 | Issue 1

A Rare and Atypical Case Report of Combined Rupture of Patellar Tendon, Anterior Cruciate Ligament, Medial Collateral ligament, and Lateral Meniscus Managed Operatively

September 10, 2018/in Volume 4 | Issue 2 | Sep-Dec 2018

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Chronic osteomyelitis in Sarajevo, Bosnia-Herzegovina: Long-term health consequences of warfare

January 10, 2019/in Jan. - April 2019 | Volume 5 | Issue 1

Vol 5 | Issue 1 | Jan-April 2019 | page:14 -16 |Katherine O. Ryken, Semin Becirbegovic, Ismet Gavrankopetanovic, J Lawrence Marsh, Marin Schweizer.

Author: Katherine O. Ryken [1], Semin Becirbegovic [2], Ismet Gavrankopetanovic [2], J Lawrence Marsh [1], Marin Schweizer [1]

1 Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA
2 Department of Orthopedics&Traumatology, University of Sarajevo ClinicalCenter, Sarajevo, Bosnia-Herzegovina
Address of Correspondence
Dr. Katherine O. Ryken,
University of Iowa Carver College of Medicine, Iowa City, IA
E-mail: kryken@montefiore.org

Abstract

Introduction: Chronic osteomyelitis (COM) is a severely debilitating disease, causing both physical and psychological repercussions for patients. It is particularly common in austere environments and areas of armed conflict. 1,2,3 The most common cause across all age groups is neglected penetrating wounds.4 Often overlooked, COM is one of the many lasting health effects of warfare. Deep infections of the bone following penetrating and blast injuries are common in regions plagued by conflict and cause major physical and social disability.
Materials & Methods: Patient records at the University of Sarajevo Clinical Center Department of Orthopedics & Traumatology were analyzed retrospectively between 2003 and 2013 of patients hospitalized with diagnosed COM.
Results: 155 patients were hospitalized at UCCS for the treatment of chronic osteomyelitis between 2003-2013. Mean age of patients at the time of hospitalization was 56 years. The most common medical comorbidity of patients was diabetes mellitus type 2. Unemployment among patients was 46.1%. The most common cause of COM in this cohort was intentional injury associated with the war between the years of 1992-1995 (46.2%). These were caused by sniper or gunshot wounds (25.4%), landmines or unexploded ordnance (37.7%), and mortar shell explosions (28.8%). The mean hospital stay among patients with COM at UCCS was 31.10 days, although this varied widely depending upon the severity of symptoms and the type of treatment required.
Conclusion: The health burden of chronic osteomyelitis persists for many years beyond the original. Chronic pain and disability contribute to a lifetime of repeated treatments, hospital stays, and high rates of unemployment. This study describes the current burden of COM upon the population of Sarajevo, as well as serving as a foreboding prediction of what can be expected in war zones for many years in the future.
Keywords: Bosnia-Herzegovina, Sarajevo, chronic osteomyelitis, war injuries, orthopedics, infectious disease, social medicine.

References

1. Ibingira, C. B. R. Chronic osteomyelitis in a Ugandan rural setting. East Afr. Med. J.80, 242–246 (2003).
2. Beckles, V. L. L., Jones, H. W. & Harrison, W. J. Chronic hematogenous osteomyelitis in children: a retrospective review of 167 patients in Malawi. J. Bone Joint Surg. Br.92, 1138–1143 (2010).
3. Yun, H. C., Branstetter, J. G. & Murray, C. K. Osteomyelitis in military personnel wounded in Iraq and Afghanistan. J. Trauma64, S163–168; discussion S168 (2008).
4. Baldan, M., Gosselin, R. A., Osman, Z. &Barrand, K. G. Chronic osteomyelitis management in austere environments: the International Committee of the Red Cross experience. Trop. Med. Int. Health TM IH19, 832–837 (2014)
5. Tice, A. D., Hoaglund, P. A. &Shoultz, D. A. Outcomes of osteomyelitis among patients treated with outpatient parenteral antimicrobial therapy. Am. J. Med.114, 723–728 (2003).
6. Casey, K., Demers, P., Deben, S., Nelles, M. E. & Weiss, J. S. Outcomes after long-term follow-up of combat-related extremity injuries in a multidisciplinary limb salvage clinic. Ann. Vasc. Surg.29, 496–501 (2015).
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8. Geiger, S., McCormick, F., Chou, R. &Wandel, A. G. War wounds: lessons learned from Operation Iraqi Freedom. Plast. Reconstr. Surg.122, 146–153 (2008).
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10. Spellberg, B. & Lipsky, B. A. Systemic antibiotic therapy for chronic osteomyelitis in adults. Clin. Infect. Dis. Off. Publ. Infect. Dis. Soc. Am.54, 393–407 (2012)
11. Conterno, L. O. & da Silva Filho, C. R. Antibiotics for treating chronic osteomyelitis in adults. Cochrane Database Syst. Rev. CD004439 (2009). doi:10.1002/14651858.CD004439.pub2
12. Murphy, R. A. et al. Multidrug-resistant chronic osteomyelitis complicating war injury in Iraqi civilians. J. Trauma71, 252–254 (2011)..

How to Cite this article: Ryken K O, Becirbegovic S, Gavrankopetanovic I, Marsh J L, Schweizer M. Chronic osteomyelitis in Sarajevo, Bosnia-Herzegovina: Long-term health consequences of warfare. Trauma International May – Aug 2019;5(1):14-16.

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A Rare and Atypical Case Report of Combined Rupture of Patellar Tendon, Anterior Cruciate Ligament, Medial Collateral ligament, and Lateral Meniscus Managed Operatively

September 10, 2018/in Volume 4 | Issue 2 | Sep-Dec 2018

Vol 4 | Issue 2 | Sept-Dec 2018 | page: 17-19 | Naveen Mittal, Robin Bohat, Ankush Jindal, Akash Singhal.

doi- 10.13107/ti.2018.v04i02.071

Author: Naveen Mittal [1], Robin Bohat [1], Ankush Jindal [1], Akash Singhal [1].

[1] Department of Orthopaedics, Government Medical College Hospital Chandigarh.

Address of Correspondence

Dr. Naveen Mittal,
#3732 Sector 46C, Chandigarh, India.
Email: Naveen.mital0501@gmail.com

Abstract

Introduction: Extensor mechanism disruption with other ligament injuries at knee is rare. Rupture of the patellar tendon (PT) usually occurs at the inferior pole of patella leading to proximal retraction of 3–5 cm due to contraction of quadriceps. The medial collateral ligament (MCL) is the most frequently damaged ligamentous stabilizer of the knee. MCL injuries do occur as isolated lesions or in combination with damage to other ligamentous structures (meniscus and/or cruciate ligaments). Non-operative treatment is reasonable for the second-degree and some third-degree tears, but when they occur in conjunction with meniscal tears, they are best treated by surgical repair. The incidence of meniscal tears with acute anterior cruciate ligament (ACL) injuries ranges from 50% to 70%. The risk of lateral meniscus (LM) injury is high in ACL deficient knee as a result of abnormal loading and shear stress. However, simultaneous rupture of both the PT, ACL, MCL, and LM is a relatively rare injury. Our is a case of a 60-year-old male with a history of roadside accident presenting with simultaneous PT, ACL, MCL, and LM injury. We managed the patient with acute repairing of the PT with Ethibond no.5 sutures protected with stainless steel wire and the MCL repaired with Ethibond no.5 sutures. The ACL was not repaired as the limited literature has shown high incidence of arthrofibrosis in acute repair (Shelbourne et al.). Complex tear of anterior horn of LM was seen and was shaved off. We were able to achieve full extension at 3 months. In conclusion, we want to highlight the rarity of such injuries favoring the immediate repair of PT and delayed repair of ACL for achieving optimal results. The use of our treatment algorithm may facilitate clinical decision-making in an attempt to restore stability, preserve ROM, and maximize return to activity.

Keywords: Patellar tendon, Anterior cruciate ligament, Medial collateral ligament.

References

1. Carroll BS, Cvetanovich G, Heyworth BE, Van de Velde S, Gill TJ IVth. Approach to management of the patient with the multiligament-injured knee. Harvard Orthop J 2013;15:54-64.

2. Gulabi D, Erdem M, Bulut G, Saglam F. Neglected patellar tendon rupture with anterior cruciate ligament rupture and medial collateral ligament partial rupture. Acta Orthop Traumatol Turc 2014;48:2315.

3. Kim DH, Lee GC, Park SH. Acute simultaneous ruptures of the anterior cruciate ligament and patellar tendon. Knee Surg Relat Res 2014;26:56-60.

4. Tsarouhas A, Iosifidis M, Kotzamitelos D, Traios S. Combined rupture of the patellar tendon, anterior cruciate ligament and lateral meniscus: A case report and a review of the literature. Hippokratia 2011;15:178-80.

5. Brunkhorst J, Johnson DL. Multiligamentous knee injury concomitant with a patellar tendon rupture. Healioorthopaedics 2015;38:45-8.

6. Cox CL, Spindler KP. Multiligamentous knee injuries–surgical treatment algorithm. N Am J Sports Phys Ther 2008;3:198-203.

7. Levakos Y, Sherman MF, Shelbourne KD, Trakru S, Bonamo JR. Simultaneous rupture of the anterior cruciate ligament and the patellar tendon. Six case reports. Am J Sports Med 1996;24:498-503.

8. Costa-Paz M, Muscolo DL, Makino A, Ayerza MA. Simultaneous acute rupture of the patellar tendon and the anterior cruciate ligament. Arthroscopy 2005;21:1143.

9. Rae PJ, Davies DR. Simultaneous rupture of the ligamentum patellae, medial collateral, and anterior cruciate ligaments: A case report. Am J Sports Med 1991;19:529-30.

10. Chow FY, Wun YC, Chow YY. Simultaneous rupture of the patellar tendon and the anterior cruciate ligament:a case report and literature review. Knee Surg Sports Traumatol Arthrosc 2006;14:1017-20.

11. Futch LA, Garth WP, Folsom GJ, Ogard WK. Acute rupture of the anterior cruciate ligament and patellar tendon in a collegiate athlete. Arthroscopy 2007;23:112-e1.

12. Merritt AL, Wahl CJ. Rationale and treatment of multiple-ligament injured knees: the Seattle perspective. Oper Techn Sports Med 2011;195:1-72.

How to Cite this article: Mittal N, Bohat R, Jindal A, Singhal A. A Rare and Atypical Case Report of Combined Rupture of Patellar Tendon, Anterior Cruciate Ligament, Medial Collateral ligament, and Lateral Meniscus Managed Operatively. Trauma International Sep-Dec 2018;4(2):17-19.

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A Rare and Atypical Case Report of Combined Rupture of Patellar Tendon, Anterior Cruciate Ligament, Medial Collateral ligament, and Lateral Meniscus Managed Operatively

A Rare and Atypical Case Report of Combined Rupture of Patellar Tendon, Anterior Cruciate Ligament, Medial Collateral ligament, and Lateral Meniscus Managed Operatively

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A Rare and Atypical Case Report of Combined Rupture of Patellar Tendon, Anterior Cruciate Ligament, Medial Collateral ligament, and Lateral Meniscus Managed Operatively

Author: Naveen Mittal [1], Robin Bohat [1], Ankush Jindal [1], Akash Singhal [1].

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