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Cilj ovog istraživanja je bio utvrditi na uzorku od 13 utakmica odnosno 26 suprostavljenih ekipa koje od ukupno 18 prediktorskih varijabli, šesnaest (16) čine pokazatelji situacijske efikasnosti u fazi napada i ukupno dvije (2) u fazi obrane situacijskog djelovanja rukometašica u igri, najviše utječu na pozitivan is hod rukometnih ekipa u skupini B, na ženskom olimpijskom turniru u Tokyu 2020. godine, obzirom na kriterijsku varijablu pobjedu – poraz. Ukupno četiri (4) varijable statistički značajno doprinose objašnjenju kriterijske varijable – pobjeda poraz, na razini značajnosti (p≤0, 05). Zaključno se može konstatirati da su najznačajniji pokazatelji pre dikcije konačnog rezultata utakmica u grupnoj fazi natjecanja ujedno i model igre po kojem pobjedničke ekipe završavanja akcija sa što manjim brojem neuspješnih udaraca sa krilnih pozicija i što manje neuspješ nih udaraca na prazan gol uz što veći broj uspješnih akcija iz prodora (prolaza) uz postizanje pogodaka sa što manjim brojem neuspješno izvedenih udaraca sa pozicije 7m odnosno kod izvođenja najstrožih kazni. Dobiveni rezultati se eventualno mogu generalizirati za grupne faze natjecanja ali je ipak neophodno učiniti dodatne analize na uzorku svih utakmica ili utakmica odabranih slučajnim odabirom na cijelom na tjecanju odnosno Olimpijskim igrama te na taj način dobiti realnu sliku i model igranja pobjedničkih ekipa

Prema uzorku ispitanika koji je činio 130 nogometnih trenera, svi ispitanici smatraju da je poznavanje medicinske tematike bitno, neovisno o igračkom ili trenerskom iskustvu te o rangu natjecanja u kojem su sudjelovali. Najviše se to odnosi na poznavanje medicinske tematike u sportskom treningu djece, mladih perspektivnih sportaša, te u radu i treningu s vrhunskim i profesionalnim sportašima. Ni jedan od 130 ispitanih trenera ne smatra da je potreba za poznavanjem medicinske tematike nebitna i svatko od njih ne smatra da je angažman liječnika nepotreban u procesu rehabilitacije igrača nakon ozljede. S obzirom da treneri smatraju da je poznavanje medicinske problematike bitno, a sami nemaju dovoljno znanja, preporuka je da se na službenim seminarima ili edukacijama treneri dodatno educiraju upravo u području medicine, koja je iznimno važna za trenažni, natjecateljski i rehabilitacijski proces kojeg oni nadziru.

Nakon provedene pregledne analize radova te s obzirom na sve navedene zdravstvene prednosti redovitog tjelesnog vježbanja i povećanja općenite kvalitete života, možemo zaključiti da premali postotak ljudi provodi redovitu tjelesnu aktivnost. Potrebno je provoditi edukaciju od najranije životne dobi kako bi se stekle navike za redovitim tjelesnim vježbanjem tijekom cijelog života, ali i edukaciju o svim prednostima tjelesne aktivnosti i tjelesnog vježbanja za organizam čovjeka.

The aim of the present investigation was to verify the responses of haematological and iron concentrations in Croatian U-21 soccer players following an official soccer match. A group of 19 trained, healthy male soccer players from the U-21 category of the Croatian soccer association took part in this study. An analysis of red blood cell concentration (RBC), haemoglobin (Hb), haematocrit (Htc), mean corpuscular volume (MCV), mean cell haemoglobin (MCH), mean cell haemoglobin corpuscular (MCHC), and Thrombocytes was performed to indicate the haematological status. In addition, iron, total iron binding capacity (TIBC), the unsaturated iron-binding capacity (UIBC) and ferritin analyses were obtained immediately after the soccer match. A significant decrease in Hct (%) was observed immediately after the game. However, there were no significant changes in the haemoglobin levels. Iron concentration increased significantly (p< 0.01) after the soccer match. Ferritin levels were also higher at the end of the match compared to baseline measures. It can be reported that a soccer match may induce an iron increase immediately after the game which was contradictory to recent studies. In summary, this study provided a valuable opportunity to study biochemical parameters that could lead to a possible illness, injuries and severity in match-play.

The purpose of this study was to revise the clinical use of commercial BMP2 (Infuse) and BMP7 (Osigraft) based bone devices and explore the mechanism of action and efficacy of low BMP6 doses in a novel whole blood biocompatible device OSTEOGROW. Complications from the clinical use of BMP2 and BMP7 have been systemically reviewed in light of their role in bone remodeling. BMP6 function has been assessed in Bmp6-/- mice by μCT and skeletal histology, and has also been examined in mesenchymal stem cells (MSC), hematopoietic stem cells (HSC) and osteoclasts. Safety and efficacy of OSTEOGROW have been assessed in rats and rabbits. Clinical use issues of BMP2 and BMP7 have been ascribed to the limited understanding of their role in bone remodeling at the time of device development for clinical trials. BMP2 and BMP7 in bone devices significantly promote bone resorption leading to osteolysis at the endosteal surfaces, while in parallel stimulating exuberant bone formation in surrounding tissues. Unbound BMP2 and BMP7 in bone devices precipitate on the bovine collagen and cause inflammation and swelling. OSTEOGROW required small amounts of BMP6, applied in a biocompatible blood coagulum carrier, for stimulating differentiation of MSCs and accelerated healing of critical size bone defects in animals, without bone resorption and inflammation. BMP6 decreased the number of osteoclasts derived from HSC, while BMP2 and BMP7 increased their number. Current issues and challenges with commercial bone devices may be resolved by using novel BMP6 biocompatible device OSTEOGROW, which will be clinically tested in metaphyseal bone fractures, compartments where BMP2 and BMP7 have not been effective.

Nestabilnost pešća predstavlja rijetku ozljedu ručnoga zgloba koja može uzrokovati značajnu nesposobnost i morbiditet pacijenta. Iščašenje polumjesečaste kosti je četvrti i zadnji stadij perilunatne dislokacije. Obostrano iščašenje polumjesečaste kosti je još rjeđe stanje, te je svega nekoliko sličnih slučajeva opisano u literaturi. Ovdje prikazujemo slučaj obostranog iščašenja polumjesečaste kosti ručnoga zgloba kod 27-godišnjeg muškarca, koji je zadobio ozljede oba ručna zgloba prilikom pada s drveta visokog 7 metara.

Artroskopija ručnog zgloba je minimalno invazivna endoskopska metoda koja omogućuje dijagnosticiranje i liječenje pojedinih bolesti i ozljeda ručnog zgloba (RZ), mediokarpalnog zgloba (MKZ) i distalnog radioulnarnog zgloba (DRUZ). Ovu minimalno invazivnu kiruršku metodu prvi je opisao Yung-Cheng Chen 1979., no njezina šira primjena u kliničkoj praksi počinje tek nakon 1986., kada je Terry Lane Whipple preporučio distrakciju RZ-a i precizne lokalizacije ulaznih mjesta (portala), kako bi se učinila pravilna i potpuna evaluacija RZ-a prilikom izvođenja artroskopije. Iako je prvotno artroskopija RZ-a bila samo dijagnostička metoda, tijekom vremena, zahvaljujući kontinuiranom napretku tehnologije i uvođenju inovacija u instrumentaciji i operativnoj tehnici, artroskopija RZ-a postaje i terapeutska metoda. Cilj ovog rada prikazati je osnove o artroskopiji RZ-a, a one uključuju: povijesni razvoj, indikacije i kontraindikacije, evaluaciju i probir bolesnika za artroskopiju RZ-a na temelju anamneze, fizikalnog pregleda i slikovne obrade, pripremu za artroskopiju RZ-a, potrebnu opremu, poznavanje izvanzglobne anatomije, portale (ulazna mjesta), poznavanje unutarzglobne anatomije, preduvjete, tehniku artroskopije RZ-a, prednosti i nedostatke ove operativne metode, komplikacije i zaključak., Wrist arthroscopy is minimally invasive endoscopic procedure which enables the diagnosis and treatment of certain diseases and injuries of the wrist joint (WJ), midcarpal joints (MCJs) and distal radioulnar joint (DRUJ). This minimally invasive surgical procedure was first described by Yung-Cheng Chen in 1979. However, its widespread application in clinical practice began after 1986, when Terry Lane Whipple recommended wrist distraction and precise localization of portals to do proper and complete evaluation of the wrist when performing arthroscopy. Although initially wrist arthroscopy was only a diagnostic tool, during time due to the continuous advancement of technology and the introduction of innovations in instrumentation and surgical technique, wrist arthroscopy became a therapeutic method. The aim of this professional paper is to present the basics of wrist arthroscopy, which include: historical development, indications and contraindications, evaluation and selection of patients for wrist arthroscopy on the basis of history, physical examination and diagnostic imaging procedures, wrist arthroscopy setup, the necessary equipment, superficial anatomy, portals, intraarticular anatomy, preconditions, technique of wrist arthroscopy, the advantages and disadvantages of this surgical procedure, complications, and conclusion.

Artroskopija ručnog zgloba je minimalno invazivna endoskopska metoda koja omogućuje dijagnosticiranje i liječenje pojedinih bolesti i ozljeda ručnog zgloba (RZ), mediokarpalnog zgloba (MKZ) i distalnog radioulnarnog zgloba (DRUZ). Ovu minimalno invazivnu kiruršku metodu prvi je opisao Yung-Cheng Chen 1979., no njezina šira primjena u kliničkoj praksi počinje tek nakon 1986., kada je Terry Lane Whipple preporučio distrakciju RZ-a i precizne lokalizacije ulaznih mjesta (portala), kako bi se učinila pravilna i potpuna evaluacija RZ-a prilikom izvođenja artroskopije. Iako je prvotno artroskopija RZ-a bila samo dijagnostička metoda, tijekom vremena, zahvaljujući kontinuiranom napretku tehnologije i uvođenju inovacija u instrumentaciji i operativnoj tehnici, artroskopija RZ-a postaje i terapeutska metoda. Cilj ovog rada prikazati je osnove o artroskopiji RZ-a, a one uključuju: povijesni razvoj, indikacije i kontraindikacije, evaluaciju i probir bolesnika za artroskopiju RZ-a na temelju anamneze, fizikalnog pregleda i slikovne obrade, pripremu za artroskopiju RZ-a, potrebnu opremu, poznavanje izvanzglobne anatomije, portale (ulazna mjesta), poznavanje unutarzglobne anatomije, preduvjete, tehniku artroskopije RZ-a, prednosti i nedostatke ove operativne metode, komplikacije i zaključak., Wrist arthroscopy is minimally invasive endoscopic procedure which enables the diagnosis and treatment of certain diseases and injuries of the wrist joint (WJ), midcarpal joints (MCJs) and distal radioulnar joint (DRUJ). This minimally invasive surgical procedure was first described by Yung-Cheng Chen in 1979. However, its widespread application in clinical practice began after 1986, when Terry Lane Whipple recommended wrist distraction and precise localization of portals to do proper and complete evaluation of the wrist when performing arthroscopy. Although initially wrist arthroscopy was only a diagnostic tool, during time due to the continuous advancement of technology and the introduction of innovations in instrumentation and surgical technique, wrist arthroscopy became a therapeutic method. The aim of this professional paper is to present the basics of wrist arthroscopy, which include: historical development, indications and contraindications, evaluation and selection of patients for wrist arthroscopy on the basis of history, physical examination and diagnostic imaging procedures, wrist arthroscopy setup, the necessary equipment, superficial anatomy, portals, intraarticular anatomy, preconditions, technique of wrist arthroscopy, the advantages and disadvantages of this surgical procedure, complications, and conclusion.

Prijelom skafoidne kosti s luksacijom lunatne kosti rijetka je ozljeda i čini oko tri posto svih ozljeda karpalnih kostiju. Procjenjuje se da ih se oko 25 posto kasno uoči. Pratili smo ukupno 31-og bolesnika (2 žene, 29 muškaraca) s prijelomom skafoidne kosti s luksacijom lunatne, liječenih u Klinici za traumatologiju između 2003. i 2009. godine. Prosječna dob bila je 32 godine (raspon između 17 i 66 godina) Kirurško liječenje provedeno je volarnim i/ili dorzalnim pristupom uz upotrebu titanijskog kanuliranog kompresijskog vijka (3,2 mm) postavljenog preko žice vodilice kako bi se repozicionirala skafoidna kost. Repozicija i privremena artrodeza dislociranih karpalnih kostiju obavljena je trima Kirschnerovim žicama (1,6 mm). Pacijenti su postoperativno četiri tjedna bili imobilizirani podlaktičnom volarnom longetom, a zatim im je ordinirana ortoza za šaku. Kirschnerove žice uklonjene su šest do osam tjedna nakon operacije i pacijenti su nastavili s intenzivnom rehabilitacijom ozlijeđene šake tri do šest mjeseci. Funkcionalni oporavak pratili smo primjenom Mayo Wrist Scora. Prosječno vrijeme praćenja bilo je 27 mjeseci (raspon 12 – 62 mjeseca). Prosječni rezultat Mayo-indeksa za sve pacijente iznosio je 81 (raspon 60 – 100), što se smatra dobrim rezultatom., Transscaphoid perilunate fracture dislocation is a rare injury and constitutes about 3% of all carpal injuries. It is estimated that 25% of this injury is recognized late. We followed 31 patients (2 females and 29 males) with dorsal transscaphoid perilunate fracture dislocation treated in University clinic of traumatology in the period 2003.- 2009. The average age of patients was 32 (patients were between 17 and 66 years). Surgical treatment was done with a volar and/or dorsal approach using titanium canulated headless compression screws (3.2 mm) placed via a guide wire. After surgical treatments a volar short arm splint was applied for 4 weeks and then an orthosis. Fixation with Kirschner wires were removed 6-8 weeks postoperatively and patients continued with intensive rehabilitation of the injured wrist for a period 3 to 6 months. The functional outcome assessment was based on Mayo Wrist Score. Mean follow up period was 27 months (range 12-62 months). The average Mayo Wrist Score for all patients was 81 (range 65-99) indicating good result.

Between January 2005 and May 2009, a total of 26 patients, 21 males and 5 females, were admitted for treatment of Lisfranc lesion. All patients were radiologically evaluated and classified according to the criteria proposed by Myerson: 5 (19.2%) patients had a type A injury, 2 patients (7.7%) presented with a type B1 injury, 17 (65.4%) sustained the most common type B2 injury and 1 (3.8%) patient suffered from a type C1 and C2 injury. Taking radiological and clinical findings in account, fifteen patients were elected for operative treatment and eleven patients were treated conservatively. According to type of fracture we established three groups; in group I metatarsal fracture was found in fourteen (53.9%) patients, group II with phalangeal fracture in three (11.5%) cases, whereas in group III nine (34.6%) patients sustained combined metatarsal, navicular and, most commonly, a cuneiform fracture. Using the American Orthopedic Foot and Ankle Society (AOFAS) midfoot scoring scale and SF-36 questionnaire, the functional outcome was assessed. The mean value for age distribution was 42.7 +/- 13.2 years and the mean follow up was 27.9 +/- 12.4 months. A p value < 0.005 was regarded as statistically significant for the analysis of the results. We found by means of SF 36 questionnaire a statistically significant difference in the role limitation due to existence of pain (p = 0.04) and poor general health (p = 0.013) in the group of patients that sustained combined foot fracture. The purpose of this study is to assess the treatment of Lisfranc injuries in our patients, according to SF36 and AOFAS criteria, clinical outcome was evaluated. In the group I the mean AOFAS score was 74.0 +/- 9.1 and in the group II it reached 72.0 +/- 5.2 signifying fair outcome! Poor outcome was present in the group III with mean AOFAS score 67.1 +/- 9.0. All unstable injuries require surgery. Clinical outcome is highly dependent on the restoration of normal anatomic alignment.

Between January 2005 and May 2009, a total of 26 patients, 21 males and 5 females, were admitted for treatment of Lisfranc lesion. All patients were radiologically evaluated and classified according to the criteria proposed by Myerson: 5 (19.2%) patients had a type A injury, 2 patients (7.7%) presented with a type B1 injury, 17 (65.4%) sustained the most common type B2 injury and 1 (3.8%) patient suffered from a type C1 and C2 injury. Taking radiological and clinical findings in account, fifteen patients were elected for operative treatment and eleven patients were treated conservatively. According to type of fracture we established three groups ; in group I metatarsal fracture was found in fourteen (53.9%) patients, group II with phalangeal fracture in three (11.5%) cases, whereas in group III nine (34.6%) patients sustained combined metatarsal, navicular and, most commonly, a cuneiform fracture. Using the American Orthopedic Foot and Ankle Society (AOFAS) midfoot scoring scale and SF-36 questionnaire, the functional outcome was assessed. The mean value for age distribution was 42.7 +/- 13.2 years and the mean follow up was 27.9 +/- 12.4 months. A p value < 0.005 was regarded as statistically significant for the analysis of the results. We found by means of SF 36 questionnaire a statistically significant difference in the role limitation due to existence of pain (p = 0.04) and poor general health (p = 0.013) in the group of patients that sustained combined foot fracture. The purpose of this study is to assess the treatment of Lisfranc injuries in our patients, according to SF36 and AOFAS criteria, clinical outcome was evaluated. In the group I the mean AOFAS score was 74.0 +/- 9.1 and in the group II it reached 72.0 +/- 5.2 signifying fair outcome! Poor outcome was present in the group III with mean AOFAS score 67.1 +/- 9.0. All unstable injuries require surgery. Clinical outcome is highly dependent on the restoration of normal anatomic alignment.

U završnom radu je obrađena tema složenog opterećenja ravnih štapova i to dio koji se odnosi na zajedničko djelovanje savijanja i aksijalnog opterećenja, ekscentrično opterećenje kratkih štapova, jezgru poprečnog presjeka, primjenu jezgre poprečnog presjeka pri kosom savijanju i ekscentričnom opterećenju i naprezanja u presjeku pri isključenju vlačne zone. U okviru rada riješen numerički primjer određivanja jezgre poprečnog presjeka i njene primjene pri kosom savijanju i ekscentričnom opterećenju.

The purpose of our study was to determine the importance of clostridial contamination of accidental wounds in children and the need for bacteriologic diagnosis in cases when no general clinical signs of infection by anaerobic bacteria are present. we checked the medical histories of patients treated for accidental wounds in our hosiptal over the last five years and with bacteriological findings of Clostridia in wound swabs. Clostridia were isolated in liquied and solid media. identification of bacteria was performed using commercial tests (Api ANA, bioMerieux), and antibiotic susceptibility using semi quantitative tests (anaATB, bioMerieux). Clostridia were found in 18 children, 12 with wounds, and 6 with burns. In 8 of them swabs were taken during primary treatment and in 10 of them later (between 2nd and 5th day). Clostridium perfringens was the most frequently isolated species (12), followed by Clostridium butiricum (1), Clostridium ramosum (1) and other Clostridia sp(4). in 12 wound swabs polymicrobial contamination was found. antibiotics were administrated in 14 patients. no clinical manifestation of any severe infection was found in 17 children. one child showed the clinical picture of gas gangrene. Although severe infections caused with Clostridia are rare in children, we consider bacteiologacal examination of accidental wounds necessary.

Unexpected diagnose for preauricular swelling – two case reports

Background. Preauricular swelling in children may be associated with a wide range of pathology. The history, clinical presentation and imaging features ofsuch swellings may be non-specific. Sometimes it can be caused by underlyingbone lesion. Case reports. We report about two children who were admitted to the hospital with swelling in the preauricular region and an unexpected final diagnosis. We found aneurismal bone cyst and central giant cell granuloma, respectively. Conclusions. Awareness of such lesions is important to avoid diagnostic errors and a potential mismanagement. These lesions are often difficult to differentiate on the basis of their radiographic features alone. A high-resolution US enables an accurate analysisof soft tissue and helps in the differential diagnosis. It also enables an accurate location of the lesion, which helps to avoid a wrong interpretation based on the clinical finding only. The CT scan performed afterwards provides necessary information for the assessment of location, structure and size of the lesion. Izhodišča. Pri otrocih so lahko predušesne otekline povezane z najrazličnejšimi boleznimi. Anamneza, klinični znaki in slikovne preiskave so večkrat neznačilni. Pri načrtovanju preiskav moramo pomisliti tudi, da je vzrok takšne otekline sprememba na kosti. Prikaz primerov. Poročamo o dveh primerih bolnikov, ki so bili napoteni v našo bolnico zaradi predušesne otekline in pri katerih smo nepričakovano ugotovili aneurizmalno kostno cisto in velikocelični granulom. Zaključki. Pomembna je velika pozornost pri ugotavljanju vzroka takšnih predušesnih sprememb, da se izognemu napačni diagnozi in s tem tudi napačnemu zdravljenju. Rentgenološka preiskava večkrat ne zadošča. Ultrazvok z visoko ločljivostjo omogoča natančno preiskavo mehkih tkiv in pomaga pri diferencialni diagnozi ter omogoča natančno lokalizacijo bolezenske spremembe. Dodatna CT preiskava pa prikaže mesto, strukturo in velikost bolezenske spremembe.

Tumori kostiju čine tek 5% tumora djece i iziskuju liječenje u specializiranim centrima. Najčešći simptomi su bol, oteklina smanjena pokretljivost, promjene na koži, patološki lomovi, gdje uvijek treba diferencijalno dijagnostički misliti i na tumor. Dijagnoza se postavlja rentgenskom snimkom, scintigrafijom kosti, kompjuteriziranom tomografijom, magnetskom rezonancijom, UZV i na koncu biopsijom kosti- aspiracijskom ili/i incizijskom. Tek na osnovu kliničkih nalaza, rezultata dijagnostičkih pretraga i histološke analize, a prema predviđanju tijeka bolesti, odabire se odgovarajuće liječenje. Danas se, zahvaljujući adjuvantnoj kemoterapiji, prije operacije može smanjiti tumor, unuštiti mikrometastaze i time umjesto amputacije ekstremiteta omogućiti poštedniji, manje mutilirajući operacijski zahvat u više od 70% bolesnika. Najbolji rezultati postižu se kombinacijom sistemske kemoterapije, kirurškog liječenja i radioterapije s petgodišnjim preživljenjem do 65-70% bolesnika. Najčešći zločudni tumori kostiju u djece su Ewing sarkom i osteosarkom, koji iziskuje različiti pristup i vrlo kompleksno liječenje u specijaliziranim centrima. Iznose se različitosti kemoterapijskih, operacijskih i radioterapijskih postupaka za svaki od navedenih tumora.

Morfološke značajke donjeg ekstremiteta i pojave boli u koljenu adolescenata