Patients with spinal cord injury have gastrointestinal disfunction, a late complications of their disease. The aim of this paper is need to accent prevention of gastrointestinal complication, primary by adequate defecation, which is usually forgotten.

Periarticular ossifications in paraplegics most frequently occur around the hip. Typically, the newly formed bone limits foremost flexion. The ossification takes place in the connective tissues of the muscle; its etiology and pathogenesis remain to be elucidated. In general, neither the joint nor its capsule are involved in the process of ossification. The incidence of HO in paraplegics is said to 18% of clinically relevant ossifications. There is a general consensus that surgery should only be performed after maturation of the ossification. The determination of alkaline phosphatase and a bone scan are used for assessment of osteogenic activity.

In this paper is suggested rehabilitation rule for postoperative treatment after surgical repair articular cartilage injury of knee. Rehabilitation program after this surgical treatment (autologous chondrocytw transplantation and autologous osteochondral grafts) lasts for a long time. Full success of surgical treatment is conected with proper rehabilitation program.

The author present in the retrospective analysis 10 patients (52 females, 48 males) with the condition of paraplegy in Canton Sarajevo in the period 01.01.-31.12.2002. year. In all the patients were followed the total life and working activities as are proclaim by UN 1994. The standard rules for the equal possibilities of the persons with unableness what predicts the insurance of their rights from the medical care and additional services. The results of the examination show that there does not exist one program for the professional direction and that only 8 (16%) males and 2 (4%) females employed while the rest unemployed, prematurely retired people or it is about the children it schooling. Although the persons with paraplegia get qualified as the persons with unableness of the adaptation and the life--housing adaptation only portionally performed (entrance in the flat--house 30%, bathroom/WC 26%, the thresholds 60%). They are identical the situations and with use of the utilities: wheel chair--stand--beds (92%:2%:29%). The particular caution is by the parents, marital partner 32% and 27% by brother, sister or another family member. The results which concern life of the examinees in the community show that 16% of examinees live along. The identical is the situation when ace in question also the members in the association and attending of the tuition at schools or faculties.

INTRODUCTION The injury of Achilles tendon most frequently occurs as a result of overburdening of the tendon, particularly in sportsmen (runners and jumpers) even though they are not rare in the rest of the population. Biomechanical distrubances on the burdening tendon, or its continuous burdening, result in the degenerative changes in the form of pathological tenosynovial adhesions in and around the tendon that precedes the tendon rupture. In the recent years conservative functional treatment increasingly became the method of choice due to final results of the treatment. Basic principle of this method of treatment is to establish disrupted balance between the synergist and the antagonist of the lower leg, which was caused by rupture. This helps to reduce the kinetics of the ankle and the knee joint, and to avoid long lasting classical immobilisation which has found its substitution in a vario stable shoe, which allows possibility of flexibile arthrodesis of ankle with usage of insole. MATERIALS AND METHODS The conservative functional treatment of the acute Achilles tendon rupture has been carried out on 19 patients during the period 1993-1998, at the University of Sarajevo, Clinical Center. Sex structure was 17 males and 2 female patients. Average age of the patients was 27,1 (working population). The study was shortterm with first results obtained after 12 weeks. Etiologically, in the mechanisms of the injury there were 15 spontaneous ruptures from jumps and 3 from in landing after a jump, and in a direct trauma there was one rupture reported. Two of these were sport injuries. Clinical evaluation has been done according to the Thermann score scale. Ultrasound diagnostics was done immediately after the injury, followed by control examinations in the 4th, the 8th, and the 12th week. If the vario stable boot is missing, the modified program can be applied. RESULTS After 12 weeks, the Thompson, the Simmond and the Matles signs were evaluated and the results were negative. No patient reported suffering pain. The muscular atrophy of the lower leg up to 2 cm was reported in six patients, and up 3 cm in 3 patients, while other patients had tolerable 0.5 to 1 cm atrophy. There were no reports of thromboembolism. The largest number of ruptures was verified on the crossing between the middle and the lower third by ultrasound examination (8). Complete ruptures were reported in 14 examinees, partial in 5. There were no reports of desinsertions and distensions. In the 12th week we followed the ultrasound adaptation, i.e. diastases of tendon ends in neutral position (0(0)) and functional with 20(0) of plantar flexion. There were 16 examinees without functional deficit, one with the reduced plantar flexion od 5(0), 1 with the reduced dorsal flexion od 5(0), and also one patient with 10(0) reduced dorsal flexion. After ten years (2003-2004) we reevaluated six patients according to the Thermann scor scale. Functional examinations each patients have been excellent. CONCLUSIONS All patients returned to their daily working activities. We did not record a single case with complicatoions. With regard to other methods of treatment the functional treatment is apparently without an alternative, but at the same time requires methods that seek full engagement of a surgeon, a physiatrist and the radiologist. In order to avoid compromising and make the treatment successful, it is necessary to keep up with the implementation protocol, to have available adequate corrective shoes or other means, and to possess certain level of clinical experience.

In this paper the authors give an overview of two systems (simulation and navigation) which are very important and give support to clinical work by making possible good visualization of the morphology and kinematics of joints. The approach to each patient with changes in the joints is individualized with a computer generated tomographical images which give very precise data which up to now had been inaccessible with clinical testing as the only alternative was the well known invasive diagnostic procedures. The first case concerns the COJOKS simulation system (COmputerized Joint Kinematics Simulation). The second case is of a navigation operative system which has recently been put into use and was developed on the basis of the GPS system (MSNT). This system is used for the precise determination of the bone structure of joints which is, by way of computer transformed into virtual 3D shape. This gives the surgeon all the data necessary during the operative procedure on bone and joint structures.

Due to the high incidence of voiding dysfunction (patients with SCI) in the rehabilitation setting, a safe, efficient method for monitoring residual bladder volume is needed. A controlled trial was performed to compare the use of a portable ultrasound unit that calculates bladder volume to catheterization regarding complications, speed of usage and patients feelings. Urethral catheterization, the standard method for measurement of bladder volume is associated with patient discomfort plus risks of urethral trauma and urinary tract infection. A portable ultrasound instrument Bladder Scan 3000 that automatically determines bladder volume was used for 100 patients. This instrument is a noninvasive alternative to urethral catheterization for the determination of bladder volume and it is recommended for clinicians in patients undergoing catheterization programs that can reduce the number of required catheters. It is associated with a high degree of patients satisfaction.

Authors present own experience after use surgical correction technique in order to heal the complex hallux valgus deformity. In period 1999-2002 we used this technique on 5 patients (4 females, 1 male) with 6 surgical procedures (1 female had bilateral treatment). Indications for surgical treatment were functional problems and x-ray angle between the first and second metatarsals as well as valgus angle of the first metatarsophalangeal joint which were much higher. Pre-surgical, possibility of correction angle was exact by x-ray planing. The same examination was done after surgical treatment. After surgical care and rehabilitation program all patients had well biomechanical foot relation and they had not previous functional problems.

Author analysis functional case of patients with spinal cord injury few years after injuries. We analysed 100 persons with spinal cord injury, male and female, age 7-77 years from Canton Sarajevo. Functional measurements used in physiatryes and tested all patients by Barthel index we showed qualifying for daily activities. Results are well as in literature, but we need some better.

Diagnostic error possibility and non-adequate surgical treatment by shoulder injury lead to non-adequate rehabilitation program. Authors show the case with diagnostic error and discuss the reasons for incomplete functional answer after rehabilitation-program. It is given the recommendation for solving these problems.

1. All patients returned to their daily working activities. 2. We did not record a single case with complications. 3. With regard to other methods of treatment the functional treatment is apparently without an alternative, but at the same time requires methods that seek full engagement of a surgeon, a radiologist and a physiatrist. 4. In order to avoid compromising and make the treatment successful, it is necessary to keep up with the implementation protocol, to have available adequate coeffective shoes or other means, and to possess certain level of clinical experience.