Introduction: Infections occurring in the wound as a consequence of the surgery represent the surgical field infections (SFI). Tibia diaphysis fractures are common due to its exposure to the external force. Clinical signs include: pain, swelling, lower leg deformity and skin changes. Tibia in the lower extremities has an eccentric position - from the front inner side it is covered only with the skin and from the back and the outer by muscle mass. The most common pathogens are: Staphylococcus aureus, Coagulase negative Staphylococcoc aureus or S. Epidermitis, Escherichia coli, and other. For the fracture fusion process, it is important that the skin and subcutaneous tissue above the fracture are well supplied with the blood. The American Association of Anesthesiologists defined the so-called ASA score, based on which all patients are divided into five categories according to health status before surgery. Goal: The goal of the study is to demonstrate the influence of risk factors on the occurrence of infection following osteosynthesis of tibial diaphysis, comparing emergency surgical interventions with elective. Material and methods: The study was conducted at the Clinic for Orthopedics and Traumatology of the Clinical Center of Sarajevo University during 2015 and 2016, with a total of 68 patients. Results: The age of the patient as risk factor is evident in our study, because deeper infections have had patients at the age over 60 with accompanying diseases such as Diabetes mellitus. Most of the hospitalized patients had a good health status prior to surgery, or they had ASA 1 or ASA 2 score. Surgical field infections were more common in men than in women, but the difference was not statistically significant (p>0.05). Patients who are operated as an elective surgery have longer hospitalization and more frequent surgical field infection. Also, infections are more common among smokers.

Goal: The aim of this study was to show whether the concomitant functional mitral regurgitation in patients undergoing aortic valve replacement improves after this surgical procedure and to identify preoperative echocardiographic parameters that may influence the lack of improvement in mitral regurgitation (MR) after aortic valve replacement (AVR). Material and methods: The study included 45 patients with severe aortic stenosis and concomitant moderate to severe (+2/+3)mitral regurgitation. Results: The results of our study indicated an improvement in the degree of mitral regurgitation in 24 patients. The most prominent parameters responsible for the lack of improvement of mitral regurgitation in our study were LVIDd, ERO, RVol, pulmonary artery systolic pressure and left atrial diameter. Identification of echocardiographic predictors may assist in selection of patients for whom more aggressive surgical treatment is advised. Conclusion: Concomitant moderate to severe functional MR indicates that MV should be repaired or replaced at the time of aortic valve surgery where at least two of indicated predicted preoperative echocardiographic parameters are present.

Introduction: Osteoporosis has a significant role in the etiology of thoracolumbal spinal fractures in older patients. It is the segment where the relatively immobile thoracic segment transfers into a mobile lumbar spine. The clinical picture is always with the back pain after minimal trauma or sometimes even without injury. Diagnosis always includes X-ray and then CAT scan. Treatment depends on the stability of the fracture, neurological findings, and the size of the deformity. Consequences include pain in the legs, back, spinal deformity, reduced lung function, walking disturbances, etc. Goal: In this paper we will present the patients who were treated by conservative approach for osteoporotic fractures in thoracolumbal spine. Material and methods: They were treated at the Clinic for Orthopedics and Traumatology of Clinical Center university of Sarajevo from December 1st until December 31st 2010. Patients were divided into two groups: group I consisted of patients who were treated with orthoses, and group II patients treated with plaster corset. Both treatments have their use. Results and discussion: Plaster corset gives stability; patients with orthoses are more mobile without skin changes. Orthosis is recommended for most disciplined patients and the best is that all the patients have plaster corset for six weeks, followed until the recovery by three points orthoses.

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.

INTRODUCTION Break ankle today is becoming more frequent. There is a dilemma to operate immediately upon receipt or delayed surgical treatment for a day or two. THE AIM OF THE WORK This work aims at showing the importance of the anatomy, mechanism of injury, injury classification, diagnostic and therapeutic methods in treatment of brake ankle from our experience. MATERIAL AND METHODS In the past year in our clinic there were 30 patients treated for all types of ankle fractures, and these patients were divided in two groups. Patients of the first group are those immediately operated, and the second group were with delayed surgery. The results showed that the patients of the first group had better healing, fewer complications, better and faster rehabilitation. Second groups of patients were with complications in terms dehiscence of wounds, bad healing fracture and DVT. CONCLUSION Our results showed that better result in the treatment of ankle fractures is achieved by aggressive treatment immediately after trauma, with reconstruction of articular surface and tibiofibular syndesmosis with early rehabilitation.

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.

CONFLICT OF INTEREST: NONE DECLARED Neck pain syndrome is described as: Pain in the neck affects at least once in a lifetime every second person, and also 10 % of adult population suffers from chronic pain in this area. It is more often among women. A constant increase of incidence in the industrialized countries is noticed. It is also the leading cause of referral to physical rehabilitation. It is causing huge financial costs in the health care system. There is no consensus regarding Neck pain syndrome management, but many therapeutic modalities are applied: a) to isolate (or manage) rare, but potentially dangerous states that can cause neck pain; b) identify and treat each co morbid state and risk factors; c) provide resources and information’s, especially about regarding use computers in dayly practice. Physical and manual treatments can be: a) physical therapy can assist to achieve early mobilization and return to daily activities; b) active physical therapy , mobilization, manipulation and exercises can assure short time relief of neck pain; c) home based exercises, as shown by this research, can significantly prolong the pain free period, in case of patients with the chronic syndrome; d) Medications, combined with the exercise program and ergonomic improvements can be effective solution for the chronic or recurrent neck pain. Intensive treatments in Neck pain syndrome are: a) Surgical and other intensive treatment (rarely indicated); b) invasive treatments includes and percutaneous radiofrequent neurotomy and cervical epidural analgesis.

An osteotomy is a surgical operation whereby a bone is cut to shorten, lengthen, or change its alignment. Corrective tibial osteotomies correct non-physiological axis, thus eliminating knee and ankle joint loads. In preoperative planning of the osteotomy a preoperative drawing should be made and it requires knowledge of biomechanics and physiology of the lower limbs.

Distal radius fractures are most often treated conventionally. With this paper we wish to show that by stimulating the distal radius fracture with the specific low intensity ultrasound the splicing is more rapid, complications reduced and by that also the healing time is shorter. The basic goal of the research is to reach the answer by using the adequate equipment on one group of respondents, can we with the programmed application of specific low intensity ultrasound in treatment can reach shorter joining time of the distal radius fracture compared to the controls. The research is conducted at the Clinic for Orthopedic Surgery and Traumatology of the Clinical Center in Sarajevo where we evaluated 60 patients with the distal radius fracture (intra and extra articulare) classified according to Frykman. First group of 30 patients were treated with the use of low intensity ultrasound and external immobilization, and the second group of 30 patients, with classic treatment with use of external immobilization and without use of ultrasound. Based on results we can conclude that the above mentioned treatment of distal radius fractures with use of low intensity ultrasound makes healing and course of treatment more rapid.

Politrauma is combination of the most complicated injuries caused by very strong forces. We present treatment of politraumatized patient who has injured his abdomen, with clinical and ultrasonic sings of bleeding-liver rupture, fractured pelvis and both arms and legs. All necessary diagnostic procedures have been performed and treatment team has been formed. After one year of psycical therapy, the patient can independently walk.