Introduction: Achilles tendon injuries usually occur with abrupt movements at the level of the ankle and foot, and the consequence is the overload of the Achilles tendon. Aim: Examine the Achilles tendon load as a function of the landing angle, and find the critical point at which the tendon overload begins and when a further increase in the landing angle can lead to rupture. Methods: The study has a prospective character. The input data represent the anthropometric values of the respondents, who are professional basketball players in the senior national team of Bosnia and Herzegovina and were processed in the CATIA v5-6 software solution. Software data processing analyzed the landing angles and the transfer of force to the Achilles tendon. The end result is a regression curve, which projects the angle at which the Achilles tendon is overloaded, and indicates an increased risk of possible injury to the tendon itself. Results: The onset of overloading starts at an angle of 32.28° and at an angle of 35.75° the overloaded load occurs, indicating the need for the subject to change the position of the foot to prevent damage to the tendon itself. Conclusion: An angle of 35.75° is the critical point at which the Achilles tendons are overloaded at the very landing. Prevention of injury should go in the direction of practicing the feet for a particular position at the time of the landing, and in the direction to develop adequate footwear that would mitigate the angle at the landing.

Introduction: Chronic osteomyelitis (COM) is a severely debilitating disease, causing both physical and psychological repercussions for patients. It is particularly common in austere environments and areas of armed conflict. 1,2,3 The most common cause across all age groups is neglected penetrating wounds.4 Often overlooked, COM is one of the many lasting health effects of warfare. Deep infections of the bone following penetrating and blast injuries are common in regions plagued by conflict and cause major physical and social disability. Materials & Methods: Patient records at the University of Sarajevo Clinical Center Department of Orthopedics & Traumatology were analyzed retrospectively between 2003 and 2013 of patients hospitalized with diagnosed COM. Results: 155 patients were hospitalized at UCCS for the treatment of chronic osteomyelitis between 2003-2013. Mean age of patients at the time of hospitalization was 56 years. The most common medical comorbidity of patients was diabetes mellitus type 2. Unemployment among patients was 46.1%. The most common cause of COM in this cohort was intentional injury associated with the war between the years of 1992-1995 (46.2%). These were caused by sniper or gunshot wounds (25.4%), landmines or unexploded ordnance (37.7%), and mortar shell explosions (28.8%). The mean hospital stay among patients with COM at UCCS was 31.10 days, although this varied widely depending upon the severity of symptoms and the type of treatment required. Conclusion: The health burden of chronic osteomyelitis persists for many years beyond the original. Chronic pain and disability contribute to a lifetime of repeated treatments, hospital stays, and high rates of unemployment. This study describes the current burden of COM upon the population of Sarajevo, as well as serving as a foreboding prediction of what can be expected in war zones for many years in the future. Keywords: Bosnia-Herzegovina, Sarajevo, chronic osteomyelitis, war injuries, orthopedics, infectious disease, social medicine.

We present case of nosocomial bacterial meningitis, caused by Serratia marcescens (ESBL), occurred following spinal anaesthesia. Although very rare bacterial meningitis is serious complication of spinal anaesthesia and early diagnosis as well as effective treatment is extremely important. Previously healthy individual, admitted to Orthopaedic Department for routine arthroscopy, approximately within 24 hours after operation was performed complained of headache and fever. Infectious Diseases physician was consulted, lumbar puncture was performed and purulent meningitis was confirmed. Cerebrospinal fluid and blood cultures of patient confirmed Serratia marcescens (ESBL), resistant pathogen and important nosocomial agent. Patient was successfully treated. Cases of spinal meningitis caused by Serratia marcescens are rare. Local resistance pattern is important and should be always considered when starting therapy. Infection control team was appointed because of similar case of meningitis one month before in the same Department, and after investigation discovered Serratia in anaesthetic vial used in procedures. New measures and recommendations regarding infection control were implemented at Orthopaedic Department. Meningitis as a complication should always be considered as a possible differential diagnosis with patients after spinal anaesthesia complaining on headache and fever. Early diagnosis and early treatment is extremely important. Knowledge and practice of infection control measures is mandatory and should be always emphasized to performing staff.

UNLABELLED Article presents a rare case of posttraumatic pseudoaneurysm and A-V fistula between deep femoral artery and vein in 16 year old patient with stab wound in middle third of the lateral side of left femoral region. There were no signs of arterial injury on initial angiogram. During the observation we noticed subcutaneous bruise on the posterior side of the femoral region, and strong systolic murmur by ordinary auscultation over the involved region as a significant sign of the A-V fistula. At day 3, CT angiogram and Doppler analysis showed 4 cm sized false aneurysm combined with A-V fistula between distal portion of the deep femoral artery and vein. We made ipsilateral transfemoral catheterization and coiling of the feeding arterial branch with good immediate result, but at next Doppler checking, appearance of the same picture was disappointing. After we recognized retrograde filling through distal collateral artery, technically unsuitable for endovascular procedure, conventional surgery with posterolateral approach was indicated. An excision of the pseudoaneurysm, and ligation of the A-V fistula was done with good postoperative result. CONCLUSION Obliterative endovascular procedure is a method of choice, but sometimes can not guarantee satisfactory result. In those cases conventional surgery is recommended.

Last data from 2005 shows that Bosnia and Herzegovina has 37.6 % current smokers between 18-65 years. 29.7% of them are female and 49.2 % male. In the region of Sarajevo 13.8% pupils are active smokers (16.8% boys, and 10% girls). We have evaluated smoking impact on patients in Clinical Center Sarajevo treated for occlusive arterial disease who had finished their treatment with amputation after exhausting efforts of vascular surgery and angiological therapy measures. Evaluation covers period of ten years (from 1998 to 2007) and patients treated in Vascular Surgery Department and Orthopaedic and Traumatology Department. Average age of patients was 56 year. The youngest patient was 22 and the oldest was 88 year. 70.3% of total number (990 patients) were smokers. From total number of 387 above knee amputations, 159 was done in diabetic patients - smokers which means 41.08%, or 16.06% of total number of amputations. 699 (70.6%) smoking patients underwent major amputation operations (above and below knee amputations). Only 63 patients (6.36%) without major risk factors (smoking and diabetes) had amputation as a final result of treatment. In 52 (5.25%) patients with major or other amputations we have found obliterative thromboangiitis (Buerger’s disease). In 23 patients (2.32%) with amputation we have found other inflammatory thrombotic diseases. In some cases amputation was done as urgent measure in which surgeons had no time for details in diagnostic evaluation. Smoking rates among the general population in Bosnia and Herzegovina are extremely high, and national campaigns to lower smoking rates have not yet begun.

INTRODUCTION In this report we present our experience in "post war" environment in our institution. Any king of pelvic surgery is challenging and impacts significantly on limb and visceral function. Any surgeon has to ask a question "is heroic surgery justifiable". We aim to asses functional, oncologic and surgical outcomes following pelvis tumor resections. MATERIALS AND METHODS Between 1998-2005, 7 patients (mean age 48.2 years) underwent pelvic tumor resections. All of them were primary malignant tumors. We did not identify secondary tumors and benign tumors in our series. Bone tumors were 3 osteosarcomas and 4 chondrosarcomas. Tumors involved the ilium, acetabulum, pubic bones, sacrum or a combination of these. No patient had metastases at presentation. RESULTS All 7 patients underwent hindquarter amputations. Surgical margins were marginal (4), wide (2), and radical (1). There was 1 intraoperative death, 2 local recurrences and 2 metastases. Death from disease occurred at a mean of 12.4 months with mean follow-up of 24 (1-72) months. Emotional acceptance was surprisingly high. Pelvic resections are complex. Functional outcome is significantly affected by surgery. Disease control is similar to limb tumors. Emotional acceptance of surgery in survivors was surprisingly high. CONCLUSION Major pelvic resection for malignancy appears justified.