Introduction: Hip and knee joints represent a simple functional construction composed of strong, durable material. They enable the person to make everyday, long-range and painless leg movements. Obesity progressively accelerates the arthrosis, and subsequently, the dysfunction of joints. The aim of the study: The aim of this study is to, within the test sample of 52 patients, establish the influence of obesity on the progression of primary knee and

Introduction: Acetabular fractures treatment represents a great controversy, challenge and dilemma for an orthopedic surgeon. Aim: The aim of the paper was to present the results of treatment of 96 acetabular fractures in the Clinic of Traumatology Banja Luka, in the period from 2003 to 2013, as well as to raise awareness regarding the controversy in the methods of choice in treating acetabulum fractures. Material and methods: The series consists of 96 patients, 82 males and 14 females, average age 40.5 years. Traffic trauma was the cause of fractures in 79 patients (85%), and in 17 patients (15%) fractures occurred due to falls from height. Polytrauma was present in 31 patients (32%). According to the classification of Judet and Letournel, representation of acetabular fractures was as follows: posterior wall in 32 patients, posterior column in 28, anterior wall in 4, anterior column in 2, transverse fractures in 8, posterior wall and posterior column in 10, anterior and posterior wall in 6, both- column in 4 and transversal fracture and posterior wall in 2 patients. 14 patients were treated with traction, that is, 6 patients with femoral traction and 8 patients with both lateral and femoral traction. 82 patients (86.4%) were surgically treated. Kocher-Langenbeck approach was applied in the treatment of 78 patients. In two patients from the Kocher-Langenbeck’s approach, the Ollier’s approach had to be applied as well. Two acetabular were primarily treated with Ollier’s approach. Extended Smith- Peterson’s approach was applied 4 times, and Emile Letournel’s (ilioinguinal) approach 14 times. Results: Functional outcome (after follow-up of 18 months), according to the Harris hip score of surgical treatment in 82 patients, was as follows: good 46 (56%), satisfactory 32 (39%) and poor 4 (5%). Results of acetabulum fractures treated with traction were: good 8 (57%), satisfactory 4 (28%) and poor 2 (15%). According to the Brook’s classification of heterotopic ossification, periarticular hetero-tropic calcifications after surgical treatment were: 0° in 65 patients (79%), I-II° in 9 patients (11%) and III-IV ° in 8 patients (10%). Calcifications in 14 patients treated with traction of heterotopic ossification by Brook-s classification were as follows: 0° in 10 patients (72%), I-II ° in 3 patients (22%) and III-IV° in 1 patient (6%). Conclusion: At the occurrence of acetabular fracture, it is necessary to start the treatment immediately, with an obligatory application of thromboembolic and antibiotic prophylaxis. Conservative treatment is acceptable if the dislocation of fracture is less than 5 mm. Indications for surgical treatment are incongruent or unstable fractures with verified dislocation greater than 5 mm, as well as when the radiography measured by JM Matta shows incongruence of acetabular roof less than 40° in all planes. Kocher-Langenbeck approach is the choice of surgical approach for the management of posterior column / wall, and Letournel’s (ilioinguinal) approach is the choice for the management of anterior wall/column.

Material and methods: Our study has a qualitative design. Data was collected between March and September 2013 through face-to-face interviews using open-ended questions. A qualitative content analysis method was used for analysis and interpretation of data in accordance with the Graneheim and Lundman method (2004). The participants were eight women and seven men, aged between 50 and 86 years (mean 71.4), emigrated from Bosnia and Herzegovina and diagnosed with diabetes mellitus type 2 in Sweden. They had lived in Sweden between 10 and 18 years.

Introduction: Acetabular fractures treatment represents a great controversy, challenge and dilemma for an orthopedic surgeon. Aim: The aim of the paper was to present the results of treatment of 96 acetabular fractures in the Clinic of Traumatology Banja Luka, in the period from 2003 to 2013, as well as to raise awareness regarding the controversy in the methods of choice in treating acetabulum fractures. Material and methods: The series consists of 96 patients, 82 males and 14 females, average age 40.5 years. Traffic trauma was the cause of fractures in 79 patients (85%), and in 17 patients (15%) fractures occurred due to falls from height. Polytrauma was present in 31 patients (32%). According to the classification of Judet and Letournel, representation of acetabular fractures was as follows: posterior wall in 32 patients, posterior column in 28, anterior wall in 4, anterior column in 2, transverse fractures in 8, posterior wall and posterior column in 10, anterior and posterior wall in 6, both- column in 4 and transversal fracture and posterior wall in 2 patients. 14 patients were treated with traction, that is, 6 patients with femoral traction and 8 patients with both lateral and femoral traction. 82 patients (86.4%) were surgically treated. Kocher-Langenbeck approach was applied in the treatment of 78 patients. In two patients from the Kocher-Langenbeck’s approach, the Ollier’s approach had to be applied as well. Two acetabular were primarily treated with Ollier’s approach. Extended Smith- Peterson’s approach was applied 4 times, and Emile Letournel’s (ilioinguinal) approach 14 times. Results: Functional outcome (after follow-up of 18 months), according to the Harris hip score of surgical treatment in 82 patients, was as follows: good 46 (56%), satisfactory 32 (39%) and poor 4 (5%). Results of acetabulum fractures treated with traction were: good 8 (57%), satisfactory 4 (28%) and poor 2 (15%). According to the Brook’s classification of heterotopic ossification, periarticular hetero-tropic calcifications after surgical treatment were: 0° in 65 patients (79%), I-II° in 9 patients (11%) and III-IV ° in 8 patients (10%). Calcifications in 14 patients treated with traction of heterotopic ossification by Brook-s classification were as follows: 0° in 10 patients (72%), I-II ° in 3 patients (22%) and III-IV° in 1 patient (6%). Conclusion: At the occurrence of acetabular fracture, it is necessary to start the treatment immediately, with an obligatory application of thromboembolic and antibiotic prophylaxis. Conservative treatment is acceptable if the dislocation of fracture is less than 5 mm. Indications for surgical treatment are incongruent or unstable fractures with verified dislocation greater than 5 mm, as well as when the radiography measured by JM Matta shows incongruence of acetabular roof less than 40° in all planes. Kocher-Langenbeck approach is the choice of surgical approach for the management of posterior column / wall, and Letournel’s (ilioinguinal) approach is the choice for the management of anterior wall/column.

BACKGROUND Postoperative infection after posterior spondylodesis of thoracic and lumbal spine is the most common complication, and a reason for revision surgery. Aim of this work is to analyze rate of postoperative spine infections at our institution, and to determine eventual risk factors. SUBJECTS AND METHODS In our paper we analyze incidence of deep surgical infections after posterior spondylodesis, performed on our Spine department during last 5 years (September 1, 2008 - September 1, 2013). Including criteria were: posterior spondylodesis with transpedicular screws from Th1 to S2 due to different spine indications (injuries, degenerations, deformities, tumors), absence of local or general infection prior the index surgery, surgery performed by the same surgeon (MB). Excluding criteria were: needle procedures (kypho/vertebro-plasties, nerve root and faset blocades), anterior spine surgeries, cervical spine surgeries, and decompresive surgeries. RESULTS One hundred sixty five patients with 183 surgeries have been included in this study. Early surgical infection (within a month after the surgery) has appeared at five patients (2.7%). There have been no late surgical infections. Analyzing patients' charts, we have found that Meticillin-susceptible Staphylococcus aureus (MSSA) and Methicillin-resistant Staphylococcus aureus (MRSA) have caused infections in two patients, while Clebisiela pneumoniae ESBL has caused infection in one patient. Those five patients with infections have had further risk factors: long preoperative hospitalization at four patients, polytrauma, diabetes and advanced age at one patient, each. Three patients with postoperative infection had completely non-titanium surface of implants, and other two had about 20% of non-titanium implant surface, although vast majority of surgeries have been performed by implants whose surface was completely titanium alloy. Infections have appeared between 10-30 postoperative days. In two patients where revision surgeries (debridement, drainage, antibiotic according the species) had been performed in two weeks after appearance of infection, infections have been cured. In three patients where revisions had been postponed for longer than two weeks, additional surgeries (removal of implants) were necessary for curing the infections. CONCLUSIONS This study presented that rate of infection, microbiological species and risk factors are similar to the other orthopedics procedures and other institutions. Early revision is preferable, since it effectively avoids implant removal.

ABSTRACT Introduction: Correction of pediatric spine deformities is challenging surgical procedures. This fragile group of patients has many risk factors, therefore prevention of most fearing complication-paraplegia is extremely important. Monitoring of transmission of neurophysiological impulses through motor and sensor pathways of spinal cord gives us an insight into cord's function, and predicts postoperative neurological status. Goal: Aim of this work is to present our experiences in monitoring of spinal cord motor function - MEP during surgical corrections of the hardest pediatric spine deformities, pointing on the most dangerous aspects. Material and methods: We analyzed incidence of MEP changes and postoperative neurological status in patients who had major spine correcting surgery in period April ‘11- April ‘14 on our Spine department. Results: Two of 43 patients or 4.6% in our group experienced significant MEP changes during their major spine reconstructive surgeries. We promptly reduced distractive forces, and MEP normalized, and there were no neurological deficit. Neuromonitoring is reliable method which allows us to “catch” early signs of neurological deficits, when they are still in reversible phase. Although IONM cannot provide complete protection of neurological deficit (it reduces risk of paraplegia about 75%), it at least afford a comfort to the surgeon being fear free that his patient is neurologically intact during long lasting procedures.

ABSTRACT Technological diseases are diseases of the modern era. Some are caused by occupational exposures, and are marked with direct professional relation, or the action of harmful effects in the workplace. Due to the increasing incidence of these diseases on specific workplaces which may be caused by one or more causal factors present in the workplace today, these diseases are considered as professional diseases. Severity of technological disease usually responds to the level and duration of exposure, and usually occurs after many years of exposure to harmful factor. Technological diseases occur due to excessive work at the computer, or excessive use of keyboards and computer mice, especially the non-ergonomic ones. This paper deals with the diseases of the neck, shoulder, elbow and wrist (cervical radiculopathy, mouse shoulder and carpal tunnel syndrome), as is currently the most common diseases of technology in our country and abroad. These three diseases can be caused by long-term load and physical effort, and are tied to specific occupations, such as occupations associated with prolonged sitting, working at the computer and work related to the fixed telephone communication, as well as certain types of sports (tennis, golf and others).

The aim of this study is to analyze the morphologic and functional change of human bone defect after its grafting with mixture of platelet gel and autologous cancellous bone. For one year, we have prospectively studied nine consecutive pa- tients, aged 25-73 y, with pseudoarthrosis of long bones, after unsuccessful initial surgeries. We have harvested can- cellous bone from patients' iliac crests and mixed with the ABO compatible allogeneic platelet rich plasma (PRP) gel. That mixture has been inserted in the bone defect, and surgically fixated. Radiologically, the defects achieved the bone morphology (the appearance of hazy callus) between 6th and 24th week. The time of functional recovery was varied, be- tween 12 and 40 weeks for partial weight bearing, and between 16 and 48 weeks for free limb mobility and full function of the limb. The overall healing of bone defect was 16 to 36 weeks. Two patients had complications of poor graft ingrowth and one with a reversible postsurgical nerve paresis. On the X-ray scans, solid and fast restoration of bone structure was notable, with excellent bone ingrowth, suitable for full weight bearing. The allogeneic platelet gel had no adverse effects. This method can be used for treating of long bone defects, because of its strong influence on restoration of normal bone morphology. Further investigation is required to establish efficiency relative to other methods.

ABSTRACT Introduction: Spinal pain is the most common of all chronic pain disorders. Imaging studies can be used to determine whether a pathological process is associated with the patient’s symptoms. Objective: To determine the short-term efficiency of local instillation of steroids in patients with painful spine conditions. Materials and methods: A prospective study included 35 patients with diagnosis of lumbar or cervical radiculopathy, or cervical and lumbar syndrome at the Department for the Physical Medicine and Rehabilitation, Department for the Orthopedics and Traumatology, and Department for the Neurosurgery, Clinical Canter University of Sarajevo (KCUS). A clinical examination, visual pain scale (VAS) and Oswestry Disability Index (ODI) were performed prior to the needle procedure and seven days after it. Descriptive and comparative statistics were used for comparison of pre and post-interventional results. This procedure was done for the first time in our region. Results: The males and females were equally represented in this study (17:18). The patients were 29 to 80 years old. The highest number of patients have been between 40-60 years, older then that have been 44,2% of patients, and younger only 8,5%. Patients have complained about the radicular pain along the legs or arms or back or neck pain. Most of them had disc herniation–57,14%, 8,57% had bulging disc, 8,57% had spinal canal stenosis, 5,71% had fasetarthrosis, rest of them had combination of those conditions. There was a statistically significant difference between the value of ODI score before procedure and 7 days later (26±10:16±12; p<0,001). The difference was also statistically significant in VAS values (7±1:1±1; p <0,001). Discussion: Our study suggests that needle instillation of steroid and lidocaine is effective in short-term pain occurs in different painful spine conditions (Sy cervicale, lumbare and radiculopathy). It is valuable alternative to the classic methods of physical and drug therapy. It can also postpone surgical treatment, and it is very useful in situations of diffuse degenerative changes when is very important to define exact source of pain, like for instance in hip-spine syndrome.

The aim of this work is to radiologicaly estimate the width, height and depth of bodies of thoracic and lumbal vertebras. Charts of one hundred and seventeen patients with implanted internal fixateur on the thoracic and lumbal spine, between 01.01.2008. and 31.3.2010. at the Department of Orthopedics and Traumatology - Clinical Centre Sarajevo, were retrieved, and only 14 patients, with totally 46 vetrtebras have meet including criteria (clearly visible measured structures on X-ray and CT scans, and data about implants dimensions). Digitalized anteroposterior and laterolateral X-ray, and transversal and sagital CT scans were basic inputs for measurement of height, width and depth of the vertebral body--CH, CW, CD. The correction of enlargement on X-ray pictures was performed according to known dimensions of implants and the length scale on CT scans. Enlargement of those parameters, from T1 to L5 spine level was from 60 to 100%, except the stagnation in the mid-thoracic region, and decreasing of corporal depth on the L5 vertebra (CD/L5), in comparison to the fourth vertebra (CD/L4). The clinical importance of this work is in estimation and comparison of dimensions of vertebral bodies measured on X-ray and CT scans, as the basic inputs during surgical procedures of vertebroplasty and anterior spondilodesis.

The aim of this study is to analyze the morphologic and functional change of human bone defect after its grafting with mixture of platelet gel and autologous cancellous bone. For one year, we have prospectively studied nine consecutive pa- tients, aged 25-73 y, with pseudoarthrosis of long bones, after unsuccessful initial surgeries. We have harvested can- cellous bone from patients' iliac crests and mixed with the ABO compatible allogeneic platelet rich plasma (PRP) gel. That mixture has been inserted in the bone defect, and surgically fixated. Radiologically, the defects achieved the bone morphology (the appearance of hazy callus) between 6th and 24th week. The time of functional recovery was varied, be- tween 12 and 40 weeks for partial weight bearing, and between 16 and 48 weeks for free limb mobility and full function of the limb. The overall healing of bone defect was 16 to 36 weeks. Two patients had complications of poor graft ingrowth and one with a reversible postsurgical nerve paresis. On the X-ray scans, solid and fast restoration of bone structure was notable, with excellent bone ingrowth, suitable for full weight bearing. The allogeneic platelet gel had no adverse effects. This method can be used for treating of long bone defects, because of its strong influence on restoration of normal bone morphology. Further investigation is required to establish efficiency relative to other methods.

Many malignancies in elderly population are firstly presented by spine metastases. Taking into account the complexity of metastatic diseases, it is very important to complete tumor staging and determine its pathohistology. In this paper, we present a group of patients on which a percutaneous biopsy of tumor at the Department of orthopedics and traumatology in Sarajevo was made. Including factors were: X-ray, CT or MRI diagnosed spine metastasis of thoracic or lumbar spine of unknown origin. Needle biopsy in local anesthesia was performed on 25 patients in total, and on 21 of them, we confirmed histological metastatic disease (84%). Other four patients had inadequate material for analysis and we had to repeat the procedure. Spine surgery was indicated in 8 of 25 patients (32%). Metastatic disease advanced to the rest of them (68%) and they were only indicated with chemo/radio-therapy (low Tomitta score and short life expectancy). Despite the presence of many metastases, the most symptomatic are spinal metastases. Therefore, other specialists expect orthopedic-trauma spine surgeons to be leaders of the team, although it should be oncologists. Percutaneous spine biopsy allows the acceleration of diagnostic procedure, and, as soon as possible, the beginning of definite therapy.

Aim of this study was to recognize differences in long-term clinical outcome after femoral neck fracture and hip endoprosthesis implantation. Total of 145 patients were examined, 32 patients with unipolar, 70 with bipolar and 43 patients with total hip endoprosthesis. The mean values of Harris hip score, after 3.8 ± 1.9 years, were: 72.1 ± 17.8, 74.27 ± 19.1, 78.2 ± 22.5 for patients with unipolar, bipolar and total hip endoprosthesis, respectively. No statistically significant difference was observed (p=0.704). The in-hospital mortality rates were: 4.3%, 4.6%, and 5.3% for groups of patients with bipolar, unipolar and total hip endoprosthesis, respectively. Considering clinical outcomes, general health and costs, it could be concluded that choice of endoprosthesis does not pose an obstacle in patient’s recovery.