Moldovan Medical Journal

Moldovan Medical Journal

Basic info

  • Publisher: Typography Sirius
  • Country of publisher: moldova, republic of
  • Date added to EuroPub: 2019/Sep/29

Subject and more

  • LCC Subject Category: Medical science, Health science
  • Publisher's keywords: Moldovan, Medical, Health
  • Language of fulltext: english

Publication charges

  • Article Processing Charges (APCs): Yes 200 €
  • Submission charges: No
  • Waiver policy for charges? Yes

Editorial information

Open access & licensing

  • Type of License: CC BY-SA
  • License terms
  • Open Access Statement: Yes
  • Year open access content began: 1958
  • Does the author retain unrestricted copyright? True
  • Does the author retain publishing rights? True

Best practice polices

  • Permanent article identifier: DOI
  • Content digitally archived in: eLIBRARY, CYBERLENINKA
  • Deposit policy registered in: Sherpa/Romeo

This journal has '104' articles

Risk factors in the development of acute appendicitis complications

Risk factors in the development of acute appendicitis complications

Authors: Viorel Moraru, Petru Bujor, Galina Pavliuc, Sergiu Bujor
( 1 downloads)
Abstract

Background: To study the risk factors of the development of acute appendicitis (AA) complications in adults in order to improve the results of surgical treatment. Material and methods: The research included 449 patients with AA treated surgically during the years 2015-2017 divided into 2 groups: 117 patients who were admitted with complicated appendicitis (intra- and extraabdominal complications) and 332 patients with non-complicated AA were randomly selected from the same period. The rate and characteristic of the complications evolved during the pre- and postoperative period in these two groups were specified and analyzed. Results: In the acute complicated appendicitis group (CAA), there was a predominance of women with a ratio of 1.60 versus 1.26 in the uncomplicated acute appendicitis group (NAA). The proportion of people aged> 60 years was significantly higher in the case of CAA-23.1% (n=27), while in uncomplicated AA it was only 3.9% (n=13). In the case of AA complications, there was an emphasis on late addressing, the debut-addressing term being higher compared to uncomplicated AA. The low socio-economic status has a significant negative impact on the evolution of AA and its complications, as well as on the results of appendectomy. Thus, uninsured patients (n=59, 49.6%) formed almost half of CAA group. Associated comorbidities were established in 76 or 16.9% of cases, respectively in CAA-21.4% vs 15.4% in NAA group. In summary we note that the presence of associated uncorrected comorbidities has an obvious negative impact on the development of AA. Conclusions: Our findings suggest that clinical assessment is most important for identifying individuals at risk of developing complications of AA and the above-mentioned risk factors are useful for emergency surgical decisions.

Keywords: complications of acute appendicitis, risk factors
The impact of culture media on the endothelial viability of corneas

The impact of culture media on the endothelial viability of corneas

Authors: Adrian Cociug, Olga Macagonova, Valeriu Cusnir Jr, Vitalie Procopciuc, Viorel Nacu
( 1 downloads)
Abstract

Background: The complexity of cryopreservation and its potential to damage the endothelium make it so that it is rarely used in routine eye banking, except for occasional, clinically urgent transplants, where the main objective is to save the eye. The culture medium was the method of choice in the Eye Bank. Material and methods: The study group was divided into 3 subgroups. For penetrating keratoplasty and anterior lamellar keratoplasty, corneas taken up to 24 hours, with a number greater than 2000 endothelial cells per mm2 , are preferably used. Results: In the first group we found: weakly edematous epithelium; thin, transparent stroma; thin Descemet’s membrane; transparent endothelial layer, endothelial cell density greater than 2800 cells/mm2. The corneas of the second group presented: edematous, but with uncompromised integrity epithelium; slightly edematous, transparent stroma; slightly folded Descemet’s membrane; intact endothelial layer and an average of 2600 cells/mm2. Corneas of the third group: evidently edematous epithelium, with exfoliations in some areas and Bowman’s membrane detachment; considerable edema of stroma in all layers; pronounced folds of Descemet’s membrane; interrupted endothelial layer along the outline of the folds. Conclusions: The age of the donor and the preservation time are important factors that influence corneas in culture media and determine the state of endothelial cells. Although the number of endothelial cells usually decreases with age, there are still many corneas from donors over 80 years of age who meet the minimum criteria for transplantation.

Keywords: minimum essential medium Eagle, fetal bovine serum
Comparative results in the treatment of clavicle fractures

Comparative results in the treatment of clavicle fractures

Authors: Gheorghe Rosu
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Abstract

Background: The negative results of the clavicle fractures treatment represent a high percentage, which implies the search of new methods designed to improve these results. Thus, a new method of stable and functional osteosynthesis of the clavicle fractures were proposed for this improvement, namely that performed with the external fixator. In connection with this, a comparative analysis of the results between the stability and efficacy of osteosynthesis of the the clavicle fractures by using the external fixator proposed by us and the traditional methods was conducted. Material and methods: For a better deduction and evaluation of the clavicle fractures treatment methods, it was established a task based on a clinicalradiological examination at 124 patients with clavicle fracture, which constitutes 2.7% of the number of patients hospitalized with skeletal fractures. Thus, for better surgical treatment results of clavicle fractures at the patients, was introduced a new stable and functional osteosynthesis method of the clavicle fracture treatment with an external fixator. Results: The application of the stable-functional osteosynthesis method of the clavicle fractures with an external fixator’s help succeeded in a reduction of the medium – term work incapacity, the quantity of mistakes and complications reduction and the considerable increase of the positive results of the treatment, while not neglecting the economic aspect on the background of the shortcomings exclusion of traditional surgical methods. Conclusions: The stable and functional osteosynthesis method of the clavicle fractures treatment with an external fixator versus the traditional treatment methods ensures the possibility of early functional treatment, also reducing the average of work incapacity term, mistakes and complications appeared as consequences of traditional treatment methods application and offers the possibility to use it at all specialized surgical care levels.

Keywords: osteosynthesis, external fixator, clavicular fracture
Hard palate in fetal and early neonatal periods of human ontogenesis

Hard palate in fetal and early neonatal periods of human ontogenesis

Authors: Oleksandr Slobodian, Anna Prodanchuk
( 0 downloads)
Abstract

Background: This investigation is important to reveal hard palate ontogenetic transformations in fetal and early neonatal periods, which is important for the facial surgery in fetuses, newborns. Material and methods: Investigations have been performed in 53 cadavers of fetuses from 4 to 10 months of development, and in 9 cadavers of newborn children of both genders, who died of the reasons not connected with digestive system diseases or anomalies, and were without external signs of anatomic deviations or abnormalities, and were without evident macroscopic deviations of skull structure. Adequate anatomic methods have been used for investigation: macropreparations, topographic anatomical sections, morphometry, and statistical analysis. Results: Variants of the hard palate shapes during fetal and early neonatal periods of ontogenesis are the following: trapezium (15%), square (10%), and ellipse (7%) shapes. The shapes of the trapezium were detected in most cases in 6-7-month fetuses (20%), and in equal percentage proportion in early and late fetuses (12%). The square form is a characteristic variant form in early fetuses (17%), with fetuses age increase this form was detected in less cases, in 6-7-month fetuses – in 10%, in late (8-10 month) fetuses – in 8%, and within the newborn period the square form was not observed. The form of the ellipse was observed in larger percentage proportion in late fetuses and in newborns (12%), in less proportion (5%) – in 6-7-month fetuses, in early fetuses this form was not detected at all. Forms of the ellipse and of the trapezium were observed in equal number of cases in 8-10-month fetuses and newborns. With fetuses development the hard palate form in sagittal and frontal planes changed from arcuate to flat one. Conclusions: An ascertainment of typical and variant anatomy of hard palate forms and types would promote implementation of the new methods of major and reconstructive surgical invasions in face and skull.

Keywords: hard palate, anatomy, fetus, newborn, human
Techniques of liver decellularization

Techniques of liver decellularization

Authors: Mariana Jian, Vitalie Cobzac, Ivan Moghildea, Victor Popescu, Viorel Nacu
( 0 downloads)
Abstract

Background: The growth of the number of people who need the liver transplant and the insufficiency of organ donors, have urged the advancement in bioengineering through the development of new therapeutic strategies which involve generation of functional artificial organs, obtained by the decellularization technology and creation of extracellular matrix and their subsequent recellularization. Material and methods: Rat livers (n = 9) served as the object of this study which were subjected to decellularization with sodium dodecyl sulfate (SDS) solution 0.1 and 0.5% and the combination of SDS 0.1 to 0.5% and anticoagulant. Subsequently, the extraction of nucleic acids was performed according to the protocol QIAamp Blood Mini Kit (2003). The histological analysis was performed with haematoxylin-eosin (H-E) and the quantification of hydroxyproline via spectrophotometric method. Results: After the liver tissue decellularization we obtained the matrix of decellularized liver. The genetical, biochemical and histological analysis revealed a better decellularization by the combined method versus the method with SDS solution only. Conclusions: The quantification of nucleic acids content, hydroxyproline and the histological analysis of decellularized matrix with anticoagulant and detergent SDS method, suggested a more efficient decellularization of liver tissue segments and we achieved a decellularized bioconstruction for recellularization.

Keywords: decellularization, recellularization, liver matrix
Evolution peculiarities of the flu in pregnant women

Evolution peculiarities of the flu in pregnant women

Authors: Liliana Profire
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Abstract

Background: Infection of the pregnant women in advanced period of pregnancy with any of the virus serotypes represents a danger not only for the developing fetus (e.g. fetal intrauterine retardation, fetal distress, oligoamniosis, etc.) but also for the pregnant woman who may develop respiratory and cardiovascular deficiency. We are interested to determine the peculiarities of the clinical evolution, of the flu diagnosis in pregnant women. Material and methods: The general study group consisted of 189 pregnant women which was divided into 2 clinical subgroups: L1, which included pregnant women with confirmed flu (n1 =42) A(H1N1) and subgroup L2 of pregnant women with seasonal flu (n2 =147). Results: The results of the examination of pregnant women for the flu virus’s DNK confirmed high frequency of pandemic flu in 2009, P0.05. The study of laboratory investigations of women with the flu demonstrates the presence of similar changes in the both groups: iron deficiency anemia 93 (49.2%); leukopenia 84 (44.4%); leukocytosis with neutrophilia 4 (2.1%); lymphocytosis 42 (22.2%), P>0.05. The most frequent complications of the pregnancy in pregnant women with the flu were premature delivery (early/late periods of pregnancy) – 15 (33.3±7.27) in L1 and in L2 – 35 (17.7±3.15), p<0.05, followed by intrauterine fetal infestation syndrome (fetal hypoxia, intrauterine fetal development retardation, oligoamniosis, placental dysfunction) – 33 (17.4%), p<0.05. Conclusions: Molecular methods of diagnosis to determine the virus serotype underlie the establishment of the definitive diagnosis of the flu. The risk of pregnancy disruption at various terms, premature birth, intrauterine fetus infestation syndrome are the most common complications in pregnant women with the flu in the study.

Keywords: evolution, the flu, pregnant women
Relationship between personality disorders and headaches using PID for DSM-5

Relationship between personality disorders and headaches using PID for DSM-5

Authors: Svetlana Lozovanu, Ion Moldovanu, Victor Vovc, Iuliana Romaniuc, Tudor Besleaga, Andrei Ganenco
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Abstract

Background: Studies on the specificity of migraine headache in patients with personality disorders are multiple. Results are often contradictory, which may be explained by psychological, socio-cultural, economic and purely individual differences of subjects. Material and methods: 128 patients from the Department of Headache and Autonomic Disorders of the Institute of Neurology and Neurosurgery (Chisinau, the Republic of Moldova) were evaluated in this study, in 2 stages: psychometric testing using Personality Inventory Disorders (PID-5) for DSM-5 in the 1st stage and data collection, headache intensity assessment and Headache Questionnaire in the 2nd stage. Results: The results of psychometric test allowed to separate the examined subjects into 3 groups according to numeric values of facets of PID-5: group I – Normal (0-1), group II – Accentuated Personality (1 – 1.66), group III – Personality Disorder (>1.66), and these results were correlated with intensity and frequency of headache. The analysis of 25 facets of PID-5, which are included in 5 domains of higher order: Negative Affection, Antagonism, Disinhibition, Detachment and Psychoticism, divided the domains into 3 groups: Internalization, Externalization and Psychoticism. These values were correlated again with intensity and frequency of headache. Conclusions: Female gender has a higher introversion tendency than males, introversion and neurosis is more common among women with migraine; the onset of personality disorders occurs during early youth.

Keywords: personality disorder, PID-5, headache
Myocardial revascularization in patients with coronary artery disease and diabetes mellitus

Myocardial revascularization in patients with coronary artery disease and diabetes mellitus

Authors: Оlga Yepanchintseva, Оleg Zharinov, Elena Onishchenko, Borys Тоdurov
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Abstract

Background: Diabetes mellitus (DM) is one of the most crucial risk factors for morbidity and mortality from coronary heart disease (CAD) in the contemporary world. The prevalence and rapid progression of atherosclerotic lesions leading to worse survival is a defining feature of the course of CAD in patients with DM. Clinical manifestations of CAD often call for revascularization in patients with DM. The contemporary data regarding efficacy of the coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in patients with CAD and concomitant DM are summarized in the review. Conclusions: Worse survival prognosis in case of CAD with concomitant DM is associated with systemic atherosclerosis, presence of a number of concomitant risk factors, as well as masked clinical manifestations of ischemia and myocardial infarction common for the patients with DM. The combination of CAD and DM once again proves the benefit of the long-term use of drugs for the secondary prevention of cardiovascular events. From the standpoint of evidence-based medicine the optimal method of revascularization in CAD patients with multivessel coronary artery disease and concomitant DM is CABG surgery. In FREEDOM study surgical myocardial revascularization reduced the number of endpoints compared to PCI. In the case of PCI it is advisable that eluting stents reducing the likelihood of restenosis and the need for repeated revascularization be used.

Keywords: diabetes mellitus, coronary artery disease, coronary artery bypass grafting
Fundamental aspects of cardiovascular regulation in predisposition to atrial fibrillation

Fundamental aspects of cardiovascular regulation in predisposition to atrial fibrillation

Authors: Ludmila Sidorenko, Ivan Diaz-Ramirez, Victor Vovc, Gert Baumann
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Abstract

Background: Atrial fibrillation is the most common sustained arrhythmia in cardiology. The structural factors leading to atrial fibrillation are well known, but there should be also regarded the functional factors. In 2014, the Task Force published guidelines for atrial fibrillation describing the importance of the vegetative nervous system in creating predisposition to atrial fibrillation although it describes that the mechanism is not completely clear. Furthermore, it is important to understand this mechanism, regarding the increasing number of patients affected by atrial fibrillation without any structural heart diseases. The aim of this work is to understand the physiological background of the predisposition to the appearance and recurrence of atrial fibrillation regarding the role of neural regulatory systems of the heart, especially when no structural heart diseases are present. Therefore, the following is a fundamental analysis of the neural regulation of heart rhythm, including the vegetative nervous system at its medullar and central levels and also the cerebral cortex input in heart regulation. Conclusions: The predisposition to atrial fibrillation regarding the neural regulatory systems of the heart can be pinpointed to three key factors: 1. Central over-activity; 2. Sympathetic efferent overflow towards the heart in rest state; 3. Parasympathetic exhaustion and break-down of the parasymphatetic protective function.

Keywords: atrial fibrillation, neural heart rhythm regulation, central over-activity
Supportive principles in the pharmacological management of the patients with epilepsy

Supportive principles in the pharmacological management of the patients with epilepsy

Authors: Oleg Cobileanschi, Elena Condratiuc, Ion Cazacu, Diana Popusoi
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Abstract

Background: Pharmacological management of patients with epilepsy is still a very challenging approach for the best outcome of these patients. When considering the appropriate treatment choice for patients it is necessary to take into account several factors that can influence the effectiveness and quality of life. Cancelling or changing treatment suddenly can lead to uncontrolled seizures. After a short period without seizures, many patients are tempted to abandon treatment. Cessation of treatment can be discussed after a seizure-free period for at least two years. Treatment should be discontinued gradually by reducing the dosage and constant supervision of the physician. This paper analyses briefly the general pharmacological and treatment methods in several forms of adult epilepsy. Conclusions: Management of epilepsy means more than observing the medication prescribed by the specialist. It is also important for the patient to maintain his general health status, monitor the symptoms of epilepsy and response to treatment and take care of his safety. Involvement in the management of one’s own affection can help the patient to control his condition and to continue his routine in usual manner. The objective of antiepileptic treatment is to reduce epileptic seizures to zero without intolerable side effects. New treatments should focus not only on reducing the frequency and intensity of seizures but also improving the quality of life of patients.

Keywords: patient, epilepsy, therapy and dynamics
The impact of the molecular genetic test on the diagnosis delay and outcome in patients with pulmonary tuberculosis

The impact of the molecular genetic test on the diagnosis delay and outcome in patients with pulmonary tuberculosis

Authors: Alina Malic
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Abstract

Background: The aim of the study was the assessment of the impact of the molecular genetic Xpert MTB/Rif assay on the diagnostic delay and the treatment effectiveness in pulmonary tuberculosis, according to the results of the microbiological and molecular-genetic methods, in order to optimize the management of the drug resistant tuberculosis. Material and methods: A retrospective selective study, which included 226 patients with multidrug-resistant pulmonary tuberculosis (study sample) and 78 patients with drug-susceptible pulmonary tuberculosis (control group), was performed. Patients were divided into 2 subgroups following the results of the molecular-genetic and bacteriological investigations. The study sample was divided in two groups: the 1st group included 85 patients enrolled in the treatment for drug resistant tuberculosis, according to the results of the Xpert MTB test and the 2nd group included 141 patients enrolled in the treatment DOTS plus, according to the results of the conventional cultures. Results: The impact of the molecular genetic GeneXpert MTB/Rif assay was demonstrated on early diagnosis, adequate treatment according to the drug susceptibility to rifampicin, shorter duration of the treatment, low rate of the side events, optimal treatment compliance and higher treatment effectiveness. The conventional microbiological methods contributed to the late diagnosis of the patients, high rate of the severe and complicated tuberculosis, long duration of the treatment which were reflected on the low treatment effectiveness. However the conventional culture methods allowed the treatment individualization according to the drug susceptibility tests. Conclusions: Target screening of the population with risks and compulsory investigation by GeneXpert MTB/Rif assay will diminish the rate of severe late detected forms of pulmonary tuberculosis and adapt the treatment according to the drug resistance to rifampicin.

Keywords: MDR-TB, Xpert MTB/Rif assay, treatment
Complex treatment of children with distal malocclusions and osteopathy problems

Complex treatment of children with distal malocclusions and osteopathy problems

Authors: Cristina Postaru, Victoria Malkina, Natalia Pankratova, Mihail Postnikov
( 0 downloads)
Abstract

Background: The aim of the study included interdisciplinary efficiency in treatment children with class II Angle malocclusions in association with osteopathy problems. Material and methods: there were examined 30 patients of the 6- 12 years old with class II Angle malocclusion in association with osteopathy problems. The patients were divided into two groups, the main group consists of children, who have complex treatment, and in the control group they have just orthodontic treatment. Results: The results show that patients with complex treatment have potentially positive contributions in anthropometric changes as well as in facial appearance and postural problems. The orthodontic treatment of patients, from the control group, was 1.5 times longer than in the main group. So complex treatment of patients combined with postural problems is much shorter and have a positive influence on musculoskeletal disorders than in the control group. Conclusions: Efficient complex treatment of children with malocclusion and osteopathic problems influences the duration of orthodontic treatment of class II malocclusion conditioned by distal position of mandible.

Keywords: malocclusions, orthodontic treatment, functional therapy, osteopathic treatment
Tuberculosis evolution and treatment outcome in drug addicted patients

Tuberculosis evolution and treatment outcome in drug addicted patients

Authors: Evelina Lesnic, Eugen Cotelea
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Abstract

Background: Drug injection is considered an important issue for the public health of the Republic of Moldova. In the RM the intravenous drug users (IVDU) are the key population for HIV infection, B and C hepatitis, TB and sexual transmitted diseases. The aim of the study was to assess the tuberculosis evolution and treatment outcome in intravenous drug addicted patients. Material and methods: A retrospective selective, descriptive study targeting socioeconomic, demographic, economic and epidemiological peculiarities, case-management, diagnosis of radiological aspects and microbiological characteristics of 233 patients with pulmonary tuberculosis registered in Chisinau city from 2012 to 2016 among them 48 IVDU was performed. The results were compared with a sample of 34 IVDU. Results: Men were predisposed for drug addiction and the age is younger in addicts with tuberculosis. Socioeconomic vulnerability is extended in the selected groups; however, the poverty deepness was more important in addicted patients with tuberculosis. Close contact with a sick patient predominated in addicts with tuberculosis, but nobody assessed the contact in addicts without tuberculosis. Associated diseases predominated in addicts with or without tuberculosis, more frequently were: HIV infected individuals, viral hepatitis and neurological disorders. Conclusions: Risk factors for tuberculosis in drug addicts were: unemployment and associated lack of health insurance, patient’s homeless state, middle adulthood and the immune suppressive condition – HIV infection. Major disease-related characteristic in IVDU patients was the presence of severe destructive forms of tuberculosis and "loss to follow-up" as outcome.

Keywords: tuberculosis, drug use, addiction, risk factors
Obliteration and reconstruction of the mastoid cavity with auto osteomatrix forte autograft

Obliteration and reconstruction of the mastoid cavity with auto osteomatrix forte autograft

Authors: Sergiu Vetricean
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Abstract

Background: Over the past decades, there have been a multitude of reports on the effectiveness of various techniques for the reconstruction and obliteration of the mastoid cavity. Material and methods: A comparative study on the meatotympanoplasty effectiveness using the auto osteomatrix forte autograft associated with temporal fascia and mastoid obliteration with pediculated musculoperiosteal flap in 58 patients after total tympanomastoidectomy and 59 patients after revision surgery of the evidation cavity. The patient batches were similar according to age, gender and living environment. Results: 12 months postoperatively, in all patients of both study groups was determined: significant decrease of complaints, ameliorated anatomical outcomes (small, clean and dry evidation cavity), eradication of the evidation cavity pathology, improvement of the auditory functional results (statistically significant increase in the perception of voice on whispering and speech, airway and bone conduction), improvement of the vestibular function and life quality. Conclusions: Meatotympanoplasty with the use of the auto osteomatrix forte autograft when associated with the temporal fascia and the mastoid dislocation with pediculated musculoperiosteal flap is a feasible and safe technique for pathology eradication involving the evidation cavity. The use of the autologous bone for reconstruction is effective for the stability of the external auditory canal and for the tympanic membrane. It preserves and / or restores hearing, and has a lot of advantages: is immediately available in primary and revision surgeries, is economical, does not cause inflammation processes in the body, contributes to the growth of the new bone, reduces the risk of infection, resorption and subsequent degradation and improves life quality.

Keywords: mastoidectomy, reconstruction, obliteration, auto osteomatrix forte autograft
Limited internal fixation in the distal metaepiphyseal shin fractures

Limited internal fixation in the distal metaepiphyseal shin fractures

Authors: Оlexandr Koval, Volodimir Vasyuk
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Abstract

Background: The scientific papers deal with it reporting different treatment technologies for distal tibia metaepiphysis fractures; meanwhile the complication and failure rates remain high. Material and methods: 265 patients were examined. Their average age was 45.15±15.98 years (from 18 to 86). The patients were distributed into clinical groups according to the type of surgery performed. Clinical group I included patients who underwent mini-invasive osteosynthesis with K-wires and screws (113 patients, 42.64% from general group); Clinical group ІІ included patients with external fixation osteosynthesis (36 patients, 13.58%); and Clinical group ІІІ included patients who underwent osteosynthesis with plates (116 patients, 43.77%). Results: The technology of mini-invasive osteosynthesis of distal metaepiphysis fractures of the lower leg is improved. Reposition is performed under general or conduction anaesthesia under C-arm control. Ligamentotaxis principle is applied pulling fragments by means of distractor. In case separate bone fragments are not repositioned a pricker, single-toothed tenaculum are used through separate pricks of the skin. Every step is controlled by imagic intensifier. After subluxation is eliminated and reposition completed, trans-articular fixation of fragments is performed inserting 2-3 K-wires 2 mm in diameter from the sole in the direction of the tibia middle part. Conclusions: The analysis of implementation of the improved mini-invasive osteosynthesis technology for fractures of the distal lower limb compared with the traditional methods of surgical treatment of these injuries in 265 patients from the three clinical groups demonstrated that the use of closed reposition and improved technique results in improved results and considerable reduction of costs for treatment in comparison with traditional osteosynthesis.

Keywords: mini-invasive osteosynthesis, distal shin fractures

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