Faculty of Medicine

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THE EFFECT OF WIDE SWADDLING ON ALPHA HIP ANGLE IN NEWBORNS AND INFANTS
(Институт за јавно здравје на Република Македонија = Institute of public health of Republic of Macedonia, 2025-05)
Komnenovikj, Marina
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Shabani, Ilir
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Developmental dysplasia of the hip (DDH) is one of the most common diseases of the musculoskeletal system. Hip dysplasia occurs in 1:100, which means that it is 10 times more common than hip dislocation. The position of flexion and abduction in newborns and infants is the most common recommendation to improve hip development. The aim of this research is to evaluate the effects of wide swaddling, i.e., to determine whether wide swaddling influences hip maturation in the first months after birth and whether it has an effect on increasing the alpha angle of the hip during ultrasound examination. Materials and methods: A prospective, clinical, stratified study was conducted on male and female newborns and infants with type Ia, Ib and IIa hip according to the Graf method. The subjects were divided into two groups. The first group included 20 newborns and infants using wide swaddling (40 hips monitored). The second group consisted of 23 newborns and infants who were not swaddled (46 hips monitored). The wide swaddling method involved using an additional cloth diaper and one wide swaddle diaper. Subjects underwent hip ultrasound according to the Graf method during the first hip examination at 4–8 weeks of age, and again two months after the initial assessment. Results: a simple procedure such as wide swaddling influences an increase in the alpha angle of the hip. There is an effect on hip development with faster transition from type IIa to type I according to the Graf method. After two months, the progression of hip maturation in the swaddling group was evident, while hips in the non-swaddling group remained type I and II, indicating that there is also a normal maturation in the other group. Further research is necessary to evaluate the long-term effects of wide swaddling on hip development.
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THE EFFICACY OF TRANEXAMIC ACID IN REDUCING PERIOPERATIVE BLOOD LOSS IN TOTAL HIP ARTHROPLASTY
(Македонско лекарско друштво = Macedonian medical association/De Gruyter, 2025-04)
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Atanasovski, Igor
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Komnenovikj, Marina
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Zlateska Gjurikj, Sofija
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Zlateska Damjanovikj, Aleksandra
Total hip arthroplasty (THA) is a common surgical procedure indicated for patients with hip osteoarthritis. A significant concern during THA is perioperative blood loss, which can increase the risk of postoperative anemia and the need for allogeneic blood transfusions. Tranexamic acid (TXA), a synthetic lysine analog, functions by inhibiting plasminogen activation, thereby reducing f ibrinolysis and bleeding. Recent studies have demonstrated its utility in various surgical fields, including orthopedics. A 68-year-old female with a history of chronic osteoarthritis and no significant cardiovascular or thromboembolic events presented for elective primary THA. Preoperative evaluation revealed controlled hypertension and normal coagulation profiles. In view of minimizing intraoperative bleeding and reducing transfusion requirements, the surgical team decided to use TXA as part of the blood management protocol. A single dose of tranexamic acid was administered before the skin incision according to the recommended dosage of 1 gram via slow intravenous infusion (1 ml/minute). The surgery was uneventful, with an estimated blood loss of 1331 mL calculated with the Mercuriali’s formula for blood loss. Postoperative management included routine thromboprophylaxis with enoxaparin 40 mg once daily and early mobilization. Postoperative hemoglobin was 119 g/L, and no transfusion was required. The patient had an uneventful recovery and was discharged on fifth postoperative day. TXA has been shown to significantly reduce blood loss and transfusion rates in THA without increasing thromboembolic risk when used appropriately. Multiple studies support the use of TXA, demonstrating its safety profile even in patients with controlled cardiovascular comorbidities. In this case, TXA administration effectively minimized intraoperative blood loss, maintained postoperative hemoglobin levels, and eliminated the need for transfusion. The use of TXA in THA is a valuable strategy to reduce blood loss and avoid transfusion-related complications. Further research and larger studies will continue to refine optimal dosing strategies and patient selection criteria.
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EVALUATION OF TOTAL BLOOD LOSS AFTER ADMINISTRATION OF TRANEXAIMC ACID IN TOTAL HIP ARTHROPLASTY
(MIT University Skopje, 2025-03)
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Total arthroplasty is one of the most frequent procedures in orthopedic surgery, proven to be an effective treatment that significantly improves patients' quality of life. However, it is associated with considerable perioperative blood loss which can lead to suboptimal outcomes and systemic complications. The aim of this study is to assess the total blood loss after the application of tranexamic acid in patients undergoing total hip arthroplasty surgery. A total of 64 patients were included, divided into two groups: a test group where tranexamic acid was administered intravenously and a control group where tranexamic acid was not used. The values for total blood loss and erythrocyte volume loss were statistically significantly lower in the test group. Blood loss in the control group was higher by an average of 482.19 ml. Erythrocyte loss in the control group was higher by an average of 256.28 ml. The use of tranexamic acid as a standard protocol in total hip arthroplasty is a safe and effective method to reduce total blood loss. Ultimately, this results in a reduced need for blood transfusion, a decrease in potential risks and complications associated with it, and the achievement of pharmacoeconomic benefits.
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CORRECTIVE OSTEOTOMY OF THE FIBULA IN POORLY HEALED BIMALLEOLAR FRACTURE
(MIT University Skopje, 2025-03)
Pupunoski, Aleksandar
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Atanasovski, Igor
Ankle fractures are among the most prevalent lower extremity fractures, with bimalleolar fractures accounting for 60% of cases. Proper classification using the Danis-Weber AO and Lauge-Hansen systems is crucial for guiding treatment decisions. This study presents a surgical approach for the correction of a bimalleolar fracture with fibular deformity, utilizing preoperative X-ray analysis and computer-aided calculations to determine the required osteotomy wedge dimensions. The procedure involved corrective osteotomy, plate fixation, and syndesmotic stabilization to restore anatomical alignment and joint stability. Surgical fixation remains the gold standard for unstable fractures, ensuring optimal functional outcomes. Postoperative rehabilitation plays a vital role in recovery, minimizing complications such as joint stiffness and arthritis. This case highlights the importance of precise preoperative planning, appropriate surgical techniques, and structured rehabilitation for successful management of ankle fractures.
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Evaluation of Range of Movements in Limb Lenghtening Using Ilizarov Method
(Association of Physiatrists of Republic of N. Macedonia, 2022-09)
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Shabani, Ilir
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Atanasovski, Igor
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Analysis of the results of treatment with PRP ( platelet-rich plasma) versus viscosupplements in patients with gonarthrosis
(Здружение на лекари специјализанти, 2023-11)
Shojleska, Iskra
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Manasieva, Magdalena
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Atanasovski, Igor
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Introduction: Degenerative osteoarthritis or gonarthrosis is the most common form of arthritis and is a disease that reduces the quality of life of patients. Aims: To analyze the effects of the E use of PRP (platelet-rich plasma) and viscosupplements in the conservative treatmnent of patients with different grades of gonarthrosis. Materials and methods: The research included a total number of 151 respondents - paticnts with gonarthrosis. The respondents were divided into two groups; The first group: 88 patients from the first and second grade of gonarthrosis, divided into 2 subgrouos: 44 patients treated with viscosupplements and 44 patients treated with PRP The sccond group: 63 patients with grade three of gonarthrosis, divided into 2 subgroups: 31 patients treated with viscosupplements and 32 patients treated with PRP. Results: The total score of the WOMAC index was significantly higher in the group of patients with mild symptoms (grade 1 and 2 gonarthrosis) treated with hyaluronan compared to patients with mild symptoms treated with PRP (54.59 t 17.3 vs 45.79 + 15.2). The total WOMAC score did not differ significantly between patients with more severe symptoms (grade 3 gonarthrosis) treated with both methods (65.19 10.4 VS 63.56 K 14.0; p=-0.6), Conclusion: The use of PRP, which is a new biological approach in the conservative treatment of patients with degenerative diseases, gives better results than treatment with viscosupplements in patients of the first and second grade of gonarthrosis. Treating patients L with grade hree of gonarthrosis with PRP and viscosupplements provide identical improvements in quality of life.
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PSEUDOTUMOR FOLLOWING METALONPOLYETHYLENE TOTAL HIP ARTHROPLASTY A REPORT OF THREE CASES
(Македонска асоцијација на ортопеди и трауматолози = Macedonian Association of Orthopedics and Traumatology, 2022-06)
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Introduction: One of the rare complications of the total hip arthroplasty are pseudotumors. They are defined as granulomatous or destructive cystic lesions with nonneoplastic and noninfective origin. Typically there is latent period of 2 to 15 years from the implantation of the endoprosthesis to the clinical manifestation of the lesion. Most common symptoms are pain, swelling and discomfort but also, loosening of the components of the endoprosthesis or compressive symptomatology can occur. Potential mechanisms of development of psudotumors are foreignbody reaction, hypersensitivity reaction and excessive wear debris reaction. Case reports: We report three cases of pseudotumors following metalonpolyethylene total hip arthroplasty. The first case is 76yearold women presented with pain and limited motion of the right hip, 18 years after the hip arthroplasty. The second case is 53yearold man presented with pain and swelling in the right trochanteric region, 21 years after the hip arthroplasty. The third case is 55yearold women presented with painless, large mass in the left proximal thigh, 13 years after the hip arthroplasty. All three patients were treated operatively with extirpation of the pseudotumor. Discussion: Patients with hip or groin pain, a mass, or a fluid collection following total hip arthroplasty should be carefully evaluated, especially for the presence of infection. Unfamiliarity with pseudotumors may lead clinicians and radiologists to misinterpret these masses as worrisome for malignancy. The management of pseudotumors is controversial since there is no clear consensus for optimal treatment or surveillance. Conclusion: The recognition of pseudotumor is very important considering the increasing number of surgical procedures and consequential postoperative complications. Pseudotumors are a rare but important complication occurring in hip replacement surgery using all different types of implants.

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