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Neuro-orthopaedics in Croatia: past and present.

Professor Božidar Špišić is a founder of orthopaedics in Croatia. After graduating from medical school in Graz and learning about orthopaedics in Graz, Munich, Vienna and Berlin professor Božidar Špišić returns to Croatia in 1908. He founded a private orthopaedic ward and by the year 1916 he founded a first Orthopaedic hospital in southeast Europe in Zagreb. Although at that period main focus of orthopaedic surgeons were injured during the WWI, manuscripts written by Špišić in 1916 mention problems and orthopaedic care of children who were disabled at birth. After WWII in 1946. Special hospital for protection of children with developmental difficulties Goljak was founded. Till present Goljak is a main medical centre that specializes in habilitation of children with developmental disorders. A team of doctors including specialist in paediatric neurology and specialists in physical medicine work together with physiotherapists, psychologists, occupational therapists and speech therapists. Orthopaedic surgeons from our clinic are a part of this multidisciplinary team once a week during last 15 years. In 1997 Academy of developmental rehabilitation was founded at Children´s hospital Zagreb. Children with developmental disorders are offered latest state of the art treatment and parents are included in educational program and receive adequate support. Academy of developmental rehabilitation in Zagreb is well connected with European Academy of Childhood Disability. Orthopaedic surgeons from our department visit academy´s meetings every year. Meetings of Croatian Paediatric orthopaedic society are on a regular basis about neuromuscular diseases and rehabilitation. Operative treatment for children with neuromuscular diseases on regular basis starts at our department during early 1950-s. Professor Stanka Kovačić was leading surgeon at that time. For almost 30 years CP patients were mostly operated on lower extremities and soft tissue procedures were most common procedures. Arthrodesis of foot region and wrist were also common procedures. During 1980 ties Assistant professor Šimun Šakić introduces a wide variety of surgical procedures for patients with neuromuscular diseases. From early 1980 ties he starts with one stage multilevel surgery. Surgical procedures on upper and lower extremities included bone and soft tissue surgery. Šimun Šakić was the first in Croatia to perform a total hip arthroplasty in CP patients. Today operative treatment of CP patients on a regular basis is performed at three hospitals Department of Orthopaedic Surgery at the Clinical medical canter in Zagreb performs majority of procedures in Croatia, around 150 patients a year. Paediatric orthopaedic department at Children´s hospital Zagreb and Paediatric orthopaedic department at Children´s hospital Rijeka have a long tradition in conservative treatment and also offer surgical treatment for CP patients. Nowadays Department of Orthopaedic Surgery at the Clinical medical centre in Zagreb has three paediatric orthopaedic surgeons. Operative treatment for CP patients includes soft tissue and bone procedures for contracture and deformity correction on upper and lower extremity. For more than 30 years one stage multi- level surgery is performed now including complex hip and foot reconstruction. Surgery of spinal deformities in neuromuscular patients is performed also. On outpatient basis conservative treatment using serial casting and botulinum toxin as well as orthotics is a part of care for our patients. Decision for surgery is made in a multidisciplinary fashion consulting a specialist of physical medicine educated in developmental disorders and rehabilitation. There is only one Gait analysis laboratory in Croatia and it is a part of Faculty of kinesiology at Zagreb University. On few occasions we used this lab for assessment of gait in CP patients. For the future we plan to use gait lab on a regular basis, also there is a need for Cerebral palsy registry.

Neuro-orthopaedics, History, Croatia

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