<p>Povrede adolescenata predstavljaju rastući javno zdravstveni problem. Iako fizička aktivnost ima dokazanu vi&scaron;estruku korist po zdravlje pojedinca, ona je povezana sa rizikom od povreda, posebno u zemljama sa nedovoljno razvijenim strategijama za prevenciju istih. Cilj istraživanja bio je da se utvrdi povezanost između intenzivne fizičke aktivnosti i povreda, da li nivo fizičke aktivnosti utiče na rizično i protektivno pona&scaron;anje adolescenata, i da se identifikuju okolnosti i okruženje u kom se povrede najče&scaron;će de&scaron;avaju. Za istraživanje je kori&scaron;ćena retrospektivno-prospektivna kohortna studija na odabranom uzorku adolescenata od 15-19 godina koji pohađaju srednju &scaron;kolu. Putem standardnog internacionalnog upitnika o fizičkoj aktivnosti IPAQ i dobijenog MET skora, izdvojen je deo kohorte adolescenata izložen intenzivnoj fizičkoj aktivnosti. Kontrolnu grupu činili su umereno fizički aktivni i neaktivni adolescenti. U periodu od 12 meseci registrovane su sve vrste povreda adolescenata putem upitnika o povredama. Povrede koje su zahtevale medicinski tretman registrovane su kroz zdravstvenu dokumentaciju &scaron;kolskog dispanzera, sportske ambulante doma zdravlja, hitne medicinske pomoći i urgentnog odeljenja op&scaron;te bolnice. Klasifikacija i analiza podataka o povredama izvr&scaron;ena je prema prirodi povreda (S00-T98) na osnovu Međunarodne klasifikacije bolesti (MKB-10, 1996.). Rizik za povrede bio je sedam puta veći u grupi intenzivno fizički aktivnih adolescenata u odnosu na kontrolnu grupu (RR: 7,041; 95%CI: 6,071; 8,187). Rizik za povrede koje su zahtevale medicinski tretman, prema rezultatima prikupljenim u zdravstvenim ustanovama, bio je 15 puta veći kod adolescenata koji se intenzivno bave fizičkom aktivno&scaron;ću (RR: 14,717; 95%CI: 10,652; 20,592). Fizički aktivni učenici su se najvi&scaron;e povređivali na sportskim terenima, dok su se umereno aktivni i neaktivni najče&scaron;će povređivali u kućnom okruženju. Rizik da zadobiju sportske povrede bio je 11 puta veći kod fizički aktivnih ispitanika (RR: 11,212; 95%CI: 9,013; 14,074), sa značajno vi&scaron;om stopom incidencije kod mu&scaron;karaca (82,9/100). Na treningu i utakmici povrede je zadobilo 85,2% fizički aktivnih adolescenata, dok su kod umereno aktivnih i neaktivnih sportske povrede najče&scaron;će registrovane u &scaron;kolskom okruženju (37,5%). Najvi&scaron;e povreda registrovano je u fudbalu (Inc. 4.44/1000 h), odbojci (Inc. 3.92/1000 h) i boksu/kik boksu (Inc. 3.75/1000 h). Intenzitet fizičke aktivnosti nije imao uticaja na smanjenje rizičnog pona&scaron;anja kod adolescenata, kao &scaron;to je kori&scaron;ćenje alkohola, psihoaktivnih supstanci i nasilno pona&scaron;anje. Nivo protektivnog pona&scaron;anja bio je generalno nizak u obe grupe ispitanika. Kori&scaron;ćenje za&scaron;titne kacige i za&scaron;titne sportske opreme bilo je značajno zastupljenije u grupi intenzivno fizički aktivnih adolelescenata, ali nije utvrđen njihov uticaj na smanjenje rizika od povreda.</p> / <p>Injuries among adolescents represent growing public health issue. Although physical activity provides proven multiple benefits to the health of individuals, it is also associated with a risk of injuries, particularly in countries with less developed strategies for their prevention. The objective of the research was to determine the relation between vigorous physical activity and injuries, whether the level of physical activity affects the risk and protective behaviour among adolescents, and to identify the circumstances and environment in which the injuries most often occur. The research used a retrospective-prospective cohort study on a selected sample of adolescents aged 15-19 years attending secondary school. The part of the cohort of adolescents exposed to vigorous physical activity was separated through the standard international questionnaire on physical activity IPAQ and the resulting MET score. The control group consisted of moderately physically active and inactive adolescents. All types of injuries among adolescents within the 12 months were registered through a questionnaire. Injuries requiring medical treatment were registered through the health records of school and sports ambulances, emergency medical services and Emergency Department of the General Hospital. Classification and analysis of injury data was performed according to the nature of the injuries (S00 - T98) based on the International Classification of Diseases (ICD - 10, 1996). The risk of injury was seven times higher in the group of vigorous physically active adolescents than in the control group (RR: 7,041; 95%CI: 6,071; 8,187). The risk of injuries that required medical treatment was 15 times higher among adolescents who are intensively engaged in physical activity (RR: 14,717; 95%CI: 10,652; 20,592). Physically active students are most frequently injured on the sports fields, while moderately active and inactive students are most frequently injured in the home environment. The risk to suffer sports injuries was 11 times higher among physically active participants (RR: 11,212; 95%CI: 9,013; 14,074) with a significantly higher incidence rate among men (82,9/100). On training and during the game 85,2% of physically active adolescents suffered from injuries, while among inactive participants sports injuries were most often registered in the school environment (37,5%). The most injuries were registered in soccer (Inc. 4.44/1000 h), volleyball (Inc. 3.92/1000 h) and boxing/kick boxing (Inc. 3.75/1000 h). The intensity of physical activity had no impact on reducing risk behaviour among adolescents, such as the use of alcohol, psychoactive substances and violent behavior. The level of protective behavior was generally low in both groups. The use of protective helmets and protective sports equipment was significantly more frequently present among vigorous physically active adolescents, but their influence on reducing the risk of injuries was not determined.</p>

<p>Kompleksnost visokoenergetskih preloma platoa i pilona tibije i njihova udruženost sa značajnim povredama mekog tkiva oko pripadajućeg zgloba veoma je dobro opisana. Lečenje ima za cilj da multifragmentarni prelomi platoa i pilona tibije postanu stabilni, artikularno poravnani, bezbolni, da koleno i skočni zglob budu pokretni i da se minimizira rizik do nastanka posttraumatskog osteoartritisa. Aparat po Ilizarovu sa nategnutim iglama, koristi opterećenje da stvori jedinstvenu podr&scaron;ku za zglob i stabilnu imobilizacju preloma da se postigne njegovo srastanje. Ovo omogućuje ranu pokretljivost zgloba bez rizika od gubitka redukcije. Cilj istraživanja je procena i poređenje rezultata lečenja unutarzglobnih vi&scaron;ekomadnih preloma kostiju proksimalnog i distalnog okrajka potkolenice tretiranih spoljnjim unilateralnim rigidnim fiksatorom i aparatom po Ilizarovu primenom ASAMI ko&scaron;tanog skoring sistema i funkcionalnog skoring sistema po Karlstrom &ndash; Olerudu.Takođe je jedan od ciljeva istraživanja bio da se uoče faktori koji utiču na različite rezultate lečenja unutarzglobnih vi&scaron;ekomadnih preloma kostiju gornjeg i donjeg okrajka potkolenice tretiranih spoljnim unilateralnim rigidnim fiksatorom i aparatom po Ilizarovu. Istraživanje je dizajnirano kao kontrolisana komparativna klinička studija a podaci su se prikupljali retrospektivno i delom prospektivno na osnovu medicinske dokumentacije od 2008. do 2013. godine. Studija je u potpunosti izvedena na Klinici za ortopediju i traumatologiju Kliničkog centra Vojvodina u Novom Sadu. Studija je obuhvatila ukupno 103 ispitanika kod kojih je u toku 2008 do 2013. godine postavljena dijagnoza unutarzglobnog vi&scaron;ekomadnog preloma gornjeg ili donjeg okrajka tibije. Ispitanici koji su obuhvaćeni ovim kliničkim istraživanjem razvrstani su u tri grupe: Prvu grupu od 53 ispitanika činili su oni sa vi&scaron;ekomadnim unutarzglobnim otvorenim ili zatvorenim prelomima gornjeg ili donjeg okrajka kostiju potkolenice lečenih isključivo spoljnjim unilateralnim rigidnim fiksatorom. Drugu grupu ispitanika, njih 31, činili su oni sa vi&scaron;ekomadnim unutarzglobnim otvorenim ili zatvorenim prelomima gornjeg ili donjeg okrajka kostiju potkolenice lečenih isključivo aparatom po Ilizarovu. Treću grupu činila su 19 ispitanika sa vi&scaron;ekomadnim unutarzglobnim otvorenim ili zatvorenim prelomima gornjeg ili donjeg okrajka kostiju potkolenice koji su lečenje započeli spoljnjim unilateralnim rigidnim fiksatorom, a u kasnijem periodu zbog nastalih komplikacija (lo&scaron;e srastanje, produženo srastanje, nesrastanje, infekcija, pseudoartroza) lečenje nastavili konverzijom spoljnjeg unilateralnog rigidnog fiksatora u aparat po Ilizarovu. Osnovni izvor podataka za prikazano istraživanje bio je protokol formiran za svakog bolesnika pojedinačno, istorije bolesti i poliklinička evidencija. Za potrebe istraživanja dizajniran je protokol istraživanja gde su se prikupljeni podaci analizirali hronolo&scaron;ki : podaci o pacijentu, klinički nalaz na prijemu, postoperativni tok, monitoring aparata, klinički nalaz na otpustu i klinički nalaz na kontrolama od 6, 12 i 18 meseci. Kliničke nalaze na kontrolama na 6, 12 i 18 meseci beležili smo upotrebom skoring sistema ASAMI ( Udruženja za istraživanje i primenu metoda po Ilizarovu) &ndash; za ko&scaron;tane rezultate, i Karlstrom &ndash; Oleruda za procenu funkcionalnih rezultata. Neki do najvažnih rezultata dobijenih prilikom ovog istraživanja jesu da je najbrže vreme srastanja imala grupa Ilizarov, nakon 16&plusmn;2 nedelja. Grupa konverzija zabeležila je prosečno vreme srastanja u 17&plusmn;2 nedelji, dok je kod ispitanika u grupi fiksator zabeženo srastanje u 21&plusmn;4 nedelji. Pojava povr&scaron;nih i dubokih infekcija značajno je veća kod grupe tretiranih spoljnim unilateralnim fiksatorom nego kod grupa tretiranih aparatom po Ilizarovu. Vreme postizanje ranog, punog oslonca na operisani ekstremitet je značajno kraće kod grupe Ilizarov i konverzija nego kod grupe fiksator. Procena ko&scaron;tanih rezultata kori&scaron;ćenjem ASAMI bodovnog sistema ko&scaron;tanog srastanja ukazuje na statistički značajno bolje rezultate kod grupa Ilizarov i konverzija u odnosu na grupu spoljnji fiksator u periodu praćenja i analize na 6,12 i 18 meseci. Funkcionalni rezultati primenom sistema funkcionalne evaluacije po Karlstrom &ndash; Olerudu govore u prilog značajno statistički boljim rezultatima kod grupe Ilizarov i konverzija u odnosu na grupu spoljni fiksator u periodima praćenja i analize na 6,12 i 18 meseci. Na osnovu dobijenih rezultata dolazimo do zaključka da je tretman ispitanika sa multifragmentarnim, intraarikularnim prelomima gornjeg i donjeg okrajka kostiju potkolenice znatno efikasniji aparatom po Ilizarovu &scaron;to sveukupno daje smernice za brži i kvalitetniji oporavak ispitanika i njihov povratak svakodnevnim aktivnostima sa &scaron;to manjim posttraumatskim sekvelama.</p> / <p>The complexity of high-energy fractures of the tibia plateau and pilons and their association with significant violations of the soft tissue around the corresponding joint is well described in the literature. Main aim of the treatment is to multiple fractures of the tibia plateau and pilon become stable, articularly aligned, without pain, and with full motion in the knee and ankle joint with minimum risk for post-traumatic osteoarthritis. Ilizarov apparatus with taut needles is used to create a unique load support for the ankle and create conditions for good healing. This strong stability allows early joint movement, without risk of loss position of fracture parts. The aim of this research is assessment and comparation of the results of treatment, for intraarticular multiple fractures of the proximal and distal part of lower leg tretaed with unilateral external rigid fixator and Ilizarov apparatus, with ASAMI bone scoring system and functional scoring sistem by Karlstrom &ndash; Olerud. One of the goals of the study was to detect factors which affecting different treatment results of the intraarticular multiple fractures of the proximal and distal part of lower leg, tretaed with unilateral external rigid fixator and Ilizarov apparatus. The study was designed as a controlled comparative clinical study and data were collected retrospectively and prospectively form medical records from 2008 to 2013. The study has been fully implemented at the Department for orthopedic surgery and traumatology in the Clinical Center of Vojvodina in Novi Sad and included 103 patients who had intraarticular multiple fractures of the proximal and distal part of tibia. Subjects covered in this clinical study were classified into three groups: The first group of 53 patients were with intraartiulary multifragmentary open or closed fractures of the upper or distal part of lower leg, treated exclusively with unilateral external rigid fixator. The second group included 31 patients with intraarticular open or closed fractures of the upper or distal lower leg, treated exclusively with Ilizarov apparatus. 19 patients made the third group with intraarticulary open or closed fractures of the upper or distal lower leg, which were treated at the begining with unilateral external rigid fixator and later because of the complications (poor or prolonged healing, nonunion, infection and pseudoarthrosis) tretment was continued by Ilizarov apparatus. The main source of data for this study was protocol wich was established for each patient individually. In this protocol collected data analyzed by date: patient data, clinical findings at admission, postoperative course, monitoring apparatus, clinical findings at discharge and clinical findings at the controls which were at 6, 12 and 18 months after surgery. Clinical findings at control examinations (6, 12 and 18 months after surgery), we recorded by scoring system ASAMI (Association for the Study and Application of the Methods of Ilizarov) - that represent the results of the bone healing, and Karlstrom - Olerud for assessment functional outcomes. The most important results were: the fastest time of bone union was in the group of Ilizarov, and it was after 16 &plusmn; 2 weeks and the third group (conversion group) recorded an average time after 17 &plusmn; 2 weeks, while the patients in the first group (external fixator) had average time of union after 21 &plusmn; 4 week. The appearance of superficial and deep infection was significantly higher in the group treated with unilateral external fixator than in the group treated by the Ilizarov apparatus. Fastest full weight bearing on the injured leg, had patients in the group treated with Ilizarov apparatus. Evaluation of results using bone ASAMI fusion scoring system indicating a statistically significantly better results in the conversion and Ilizarov group compared to the group of external fixator in the period of monitoring at 6,12 and 18 months after surgery. Functional results by Karlstrom - Olerud scoring system show statistically significantly better results in the Ilizarov and conversion group contrary to the external fixator group in periods of monitoring at 6,12 and 18 months. Based on these results we conclude that the treatment of subjects with intraarticulary, multifragmentary fractures of the upper and lower part of the lower leg are more efficient after Ilizarov apparatus which provides overall guidance for faster and better recovery of patients and their return to their daily activities with minimal post-traumatic sequelae.</p>