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.

The aim of this work is to measure clinically important dimensions 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 for Orthopedics and Traumatology, of the Sarajevo Clinical center were retrieved, and only 14 patients, with 46 vetrtebras and 89 pedicles have had complete documentation (clearly visible measured structures on X-ray and CT scans). Digitalized antero-posterior and latero-lateral X-ray, and transversal and sagital CT scans were basic inputs for measurement of height and width of the pedicle--PH, PW, axial and vertical cortico-cortical transpedicular distances--AL, VL, and interpedicular distance--IP. The correction of enlargement on X-ray pictures was performed according to known dimensions of implants and length scale on CT scans. Enlargement of those parameters, from T1 to L5 level was from 50 to 150%. This increasing was not always linear, sometimes there was even decreasing. For instance, the IP on second and third thoracic vertebra was shorter compared to the first thoracic vertebra. Pedicles from the third to the eighth thoracic vertebra were narrower compared to the second thoracic vertebra. The importance of this work is in to analyze the mentioned dimensions by methods available to the clinician. Every other in vivo measurement is impossible because of the excessive surgical approach, while preoperative CT scanning with a great number of slices per one millimeter for this purpose is not ethical.

The implantation of a bipolar partial hip endoprosthesis is a treatment of choice for displaced medial femoral neck fracture. We present an experimental study which asses and compare biomechanical and clinical status through period before and after hip fracture and implantation of bipolar partial hip endoprosthesis. This study encompassed 75 patients who suffered from an acute medial femoral neck fracture and were treated with the implantation of a bipolar partial hip endoprosthesis. Their biomechanical status (stress distribution on the hip joint weight bearing area) and clinical status (Harris Hip Score) were estimated for the time prior to the injury and assessed at the follow-up examination that was, on average, carried out 40 months after the operation. Despite ageing, the observed Harris Hip Score at the follow-up examination was higher than that estimated prior to the injury (77.9 > 69.6; p = 0.006). Similarly, the hip stress distribution was reduced (2.7 MPa < 2.3 MPa; p = 0.001). While this reduction can be attributed to a loss of weight due to late ageing, the principal improvement came from the operative treatment and corresponding restoration of the biomechanical properties of the hip joint. The implantation of a bipolar partial hip endoprosthesis for patients with displaced medial femoral neck fractures improves the biomechanical and clinical features of the hip, what should have on mind during making decision about treatment.

Aim of this study was to estimate how knee osteoarthritis (OA) affects the shape of femoral condyles by comparing the radiuses of condylar curves between healthy and OA knees. Seventeen female and five male patients with established diagnosis of knee OA were included in the study. Radiuses of medial and lateral condylar curves were calculated from the side view knee X-ray by original mathematical equation and compared to referent values of healthy knees, after adjusting to body height. The average radiuses of condylar curves were between 52.6 +/- 6.2 and 17.6 +/- 3.5 mm medially, and between 43.3 +/- 8.4 and 15.4 +/- 3.7 mm laterally for 0 degrees and 90 degrees femoral flexion contact points, respectively The OA knees had longer curve radiuses medially and laterally at 0 degrees, 10 degrees, and 20 degrees femoral flexion contact points in comparison to the healthy sample (P < 0.001; t-test). Our results suggest that the shape of the femoral condyles in OA knees is changed. It should be aware not only in researching of OA etiology, but also in designing of knee endoprostheses, in a manner to achieve better individual sizing.