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.

INTRODUCTION Developmental hip disorder (DHD) is a disorder in development of the acetabulum which remains abrupt (dysplasia) and probably consequential cranialisation of the femur head (luxation). AIM OF THE PAPER The aim of this paper is to establish the total number of DHD and its subtypes at the first clinical and ultrasound exam of newborns in a retrospective-prospective study made in the period from 1st Jan 2006 through to 31 Dec 2010 at the Clinic for orthopaedics and traumatology in Banja Luka. MATERIALS AND METHODS In total 6132 patients were examined and 99 cases diagnosed with DHD (dysplasia and luxation). Ultrasonic exam was done by means of electronic probe of 5-12 MHz according to standard method after Graph. Girls were significantly more present (96%). Positive family anamnesis on DHD was present with 7.8% examinee, mainly with primiparas, and/ or with 77.8% children with DHD. Dominant intrauterine risk factors for DHD were: mal position of foetus in uterus (78.6%), oligoamnion (17.9%), malformation of the spinal column of the pregnant woman (3.6%), whereas with 38.4% of children with a certain form of DHD the following were found: breech presentation, caesarean section or twin pregnancy. The clinical exam indicated DHD with 8.87% examinee, out of which hip looseness was found with 5% examinees. Ultrasonic finding was positive with 99 examinee, that is with 1.61% of them (deficient and badly formed acetabulum, sleeked protrusion; 8 luxations and 91 dysplasia). Prophylactic measures were requested by 58.6% children (abductive bending and exercises), whereas 41.4 % needed non-intervention therapeutic measures (traction, Pavlik's straps, Graph's knickers, plastering), after which there were no children needing surgical correction of DHD. CONCLUSION These data indicate that clinical exam is unreliable for DHD diagnostics, and that Ultrasonic diagnostics and treatment of DHD should start as early as possible applying atraumatic helping devices and procedures in the period when all structures are elastic, flexible and adaptable.

INTRODUCTION From all deceases and injuries of femur, most surgical, medical, social and economical difficulties and problems are created by deceases and fractures of femur neck. AIM OF THE PAPER Aims of this research lie in the value of surgical approach (Hueter, Mooro and Gibson's) when anchoring hip endoprosthesis. The following parameters were analyzed: Harris Hip Score before and after the surgery, the length of the surgical incision, duration of the surgery, the amount of transfusion used, post-surgery time of the first movement to the upright position and full weight bearing. MATERIALS AND METHODS At the Orthopedic clinic in Travnik in the period from January 1st 2005 to December 31st 2009, 136 hip prosthesis were implanted. Out of that number, 56 hip prosthesis were implanted using Moor approach, 34 using Hueter approach and 46 patients were exposed to postero lateral (Gibson's) approach. All patients were treated in the same manner, operated by the same surgery team. RESULTS Hueter approach has the highest quality of surgical treatment as none of the patients had the value of the score of surgical treatment below 8. Using Hueter's approach 16 patients had the value of the score of quality of the surgical treatment between 8 and 10, whereas 18 patients had the score of quality of surgical treatment above 10. The second quality surgical treatment is Gibson's posteolateral approach at which 29 patients had the score of quality surgical treatment below 8, and 17 patients had the quality surgical treatment between 8 and 10. The worst quality of surgical treatment is Moor's approach because all 56 patients had the quality surgical treatment below 8. DISCUSSION Implantation of total endoprosthesis of dysplastic hip with adults is a demanding orthopedic surgery. The surgery of implanted hip as well as endoprosthetic materials have both improved at the satisfaction of both the patients and the surgeons. Excellent and extraordinary results were achieved over the time have become a standard. In spite of that huge surgery wound and long recovery have motivated surgeons to improve the surgery techniques. CONCLUSION With proper instruments and endoprosthesis, Hueter approach has advantages compared to Gibson and Moor's approach of implantation of endoprosthesis of aligned hip.

INTRODUCTION in fighting sports there are many opened issues related with levels of aggression and anxiety. MATERIAL AND METHODS Our study is performed with healthy young athletes: kick boxers, karate fighters, and boxers. Examined group consisted of 55 members (45 male) with average age of 20.2 +/- 3.8 years. In analysis of level of aggression Questionnaire A-87 is used. Its purpose is assessment of aggressive behaviour in provoked situations, or measurement of impulsive aggression. Questionnaire A-87 consists of 15 items of different situations with five possible responses. RESULTS AND DISCUSSION The possible responses or reactions are the five most frequent forms of aggressive responses: a) verbal manifest aggression (VM); b) physical manifest aggression (PHM); c) indirect aggression (IND); d) verbal latent aggression (VL), and e) physical latent aggression (PHL). In the analysis of anxiety is used Beck Anxiety Inventory, BAI. Average training period was 7.8 +/- 3.6 years. Even 37 athletes during sporting carriers were injured, and most of examiners (precisely 13) experienced 3 injuries. Average value of BAI was 12.7 +/- 8.7. Average value of total aggression was 152.2 +/- 40.9; highest levels were observed in VM (33.9) and VL (30.1). Significant positive correlations of all components of aggression with level of anxiety is observed (p < 0.05), most prominent IND (r = 0.4263; p = 0.0012), and VL (r = 0.4163; p = 0.0016), and also total aggression (r = 0.4822; p = 0.0002). Slightly significant positive correlation of total aggression with age of examiners is also observed (r = 0.2668, p = 0.0489). Positive correlation VM (r = 0.4928; p = 0.0001), PHL (r = 0.2761; p = 0.0413), and total aggression (r = 0.347; p = 0.0094) is observed with number of injuries of examined athletes. Also, positive correlation (r = 0.2927, p = 0.0301) is observed with level of anxiety and number of injuries. Higher level of aggression and anxiety might change attitude of some sports authorities (especially coaches), and additional psychological training of fight sports might be necessary. CONCLUSION Assessment of basically levels of aggression and anxiety of athletes might be valuable not only in sport activities, but in overall aspects of life.

UNLABELLED The adolescent idiopathic scoliosis - AIS over 40 degrees measured by Cobb, are treated by surgery. Most frequently are used corrective spondylodesis by Harrington (with hooks), by Luqe (with wires), anterior spondylodesis (with transcorporal screws). In last two decades, the posterior corrective spondylodesis by transpedicular screws is popularized. Aim of this work is to present advantages and disadvantages of posterior corrective spondylodesis of scoliosis. METHODOLOGY Twenty-three patients have been included in this study, average age of 15 y. (10-32), and mostly female gender. The dynamic and quality of postoperative flow after posterior corrective spondylodesis have been analyzed at the AIS patients on the Dept. of orthopedics and traumatology, Clinical centre University of Sarajevo during last three years. RESULTS The length of postoperative hospitalization in the analyzed group was 7 days, compared with results achieved by other methods. Faster recovery, returning to life activities, final esthetic and functional result were superior, and there was no need for revision surgery. CONCLUSION of this work is that posterior corrective spondylodesis by transpedicular screws at the AIS patients is method of choice, if all requirements of correct performing of that method are met.

INTRODUCTION The pelvis is the central part of the body that receives the weight from the vertebral column and transfers it to the lower extremities. It protects the internal organs with its specific structure and shape. OBJECTIVE The study aims to compare the clinical outcomes of emergency non-surgical and surgical treatment of such patients, to analyze the types and severity of complications and final functional outcome. MATERIAL AND METHODS We present a series of 47 patients treated in the period between 1999 and 2009 at the Traumatology Clinic, CHC Banja Luka. According to Marvin Tile's classification, fractures were distributed as follows: Type A fractures occurred in 19 patients (40.6%), Type B in 18 (38.1%) and Type C in 10 (21.3%). 30 patients (63.8%) were polytraumatised, with craniocerebral injuries in 12 patients (25.5%), chest cavity injuries in 5 (10.6%) and abdominal organ injuries in 13 patients (27.6%). 27 patients (57.4%) had clinical and laboratory signs of hemorrhagic shock on admission, while 26 patients (56.2%) received conservative treatment and 21 patients (43.8%) were treated using surgical methods of stabilization of the pelvic ring. RESULTS The analysis of the outcomes of treating pelvic ring fractures in our series of patients by using radiography (x-rays according to Slatis) showed that out of 47 treated patients, the outcomes were excellent in 28 (60%), good in 7 (15%), fair in 5 (12%) and poor in 7 (14%). The functional outcomes in all patients were evaluated according to the D'Aubigne-Postel scale, on average 18 months after the trauma. The outcomes were excellent in 22 patients (45%), good in 15 (31%), fair in 4 (9%) and poor in 6 (14%). The chi-square test showed that there was no significant statistical difference between the outcomes monitored using x-rays and functional outcomes monitored using the D'Aubigne-Postel scale (p = 0.097). The surgical treatment efficiency coefficient was introduced for the purpose of comparative evaluation of treatment outcomes. The surgical treatment efficiency coefficient, compared with conservative treatment, showed that all evaluated parameters were between 1.56 and 16.33 times lower in surgical treatment, which represents the more favorable outcome. CONCLUSION We can conclude that conservative treatment is the treatment of choice for Tile's Type A fractures, external fixator for treating Type B fractures (including all subtypes), and internal fixation, as mono therapy or in combination with external fixator, for treating Type C2 and Type C3 fractures. Surgical treatment, compared with conservative treatment, allows faster mobilisation of the patient and it shortens the recovery period, which in turn lowers the total treatment costs.

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.

A pathologic fracture is every fracture caused by minimal trauma of the bone weakened by some process (osteoporosis, tumor, etc.). Most common pathological spine fractures are compressive fractures of thoracolumbal vertebras in geriatric patients. Considering the fact that geriatric population often have numerous comorbidities, weakened bone quality, and that instrumented spondylodeses have increased surgical risk, minimally invasive procedures are treatment of the choice for described fractures. Principle of the minimally invasive treatment of compressive spine fractures is to inject bone cement percutaneously into the collapsed vertebral body through transpediculary placed cannulas, under the X-ray control. After this ambulatory procedure, patient has prompt lack of pain, full mobility; risks of surgery are lower then one promil. In this article we describe first Bosnian experiences after those surgeries (vertebroplasty, kyphoplasty, percutaneus biopsy of spine metastasis) performed at the Department for Orthopedics and Traumatology of Clinical Centre University of Sarajevo.

Hintergrund: In der vorliegenden Studie soll der Einfluss internistischer Erkrankungen auf die Rehabilitationslänge nach endoprothetischer Versorgung medialer Schenkelhalsfrakturen dargestellt werden. Patienten und Methoden: Retrospektiv wurden 493 Patienten untersucht, die im Zeitraum von Januar 1998 bis Dezember 2006 mit einer Hüftgelenkendoprothese versorgt wurden. Ergebnisse: Selbstständiges Sitzen, Stehen und Gehen erreichten Patienten mit guter Compliance signifikant früher (p = 0,0001). Pulmonale Begleiterkrankungen verlängern alle Rehabilitationsphasen wesentlich (p ≤ 0,05). Diabetes mellitus, Herzund Kreislauferkrankungen, Nierenerkrankungen oder Demenz und Parkinsonismus hatten eine nicht signifikante Verlängerung der Rehabilitationdauer (p ≥ 0,05) zur Folge. Schlussfolgerung: Vergleichsweise weniger kooperative Patienten sollten in der frühen postoperativen Phase zur Mitarbeit animiert werden, um die verlängerte und entsprechend kostenintensivere Rehabilitationsdauer zu verhindern. Begleitende Lungenerkrankungen verlängern ebenfalls die Rehabilitationsdauer. Umso bedeutender ist die Optimierung der Compliance und der perioperativen, pulmonalen Therapie in diesem Patientenkollektiv. Abstract !

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.

AIM The percentage of elderly people increases in societies today and so does the number of specific conditions, illnesses and injuries, with hip fracture as the most important one. The aim of the study was to point to hip fracture as a medical and social problem by objectively quantifying functional abilities of geriatric patients after hip fracture. PATIENTS AND METHODS The study included 414 (63 male and 351 female) with femoral neck fracture and hip endoprosthesis implanted at University Department of Traumatology in Ljubljana during the 1988-2004 period. Data on sex distribution, concomitant diseases, complications, estimation of functionality before injury, and dynamic and final level of functional recovery were collected. RESULTS The patient mean age was 77 +/- 7.3 (range 28-96) years. Excellent mobility before injury, according to personal report, was recorded in 322 (77.78%), good mobility in 78 (18.84%) and poor mobility in only 14 (3.38%) patients. The mean dynamics of functional recovery was as follows: independent sitting at 2 days, standing at 3.6 days, and walking at 7 days of the surgery. At the end of rehabilitation, an average patient felt periodic pain that did not affect his/her activities, could walk without problems at least one kilometer, limped to a certain degree, used a cane, could climb stairs holding a handrail, sat in the chair for a long time, put on shoes and socks with minor difficulties, used public transportation and had no significant deformity of the hip. With that level of functionality, our patients were independent in daily activities, able to stay socially integrated, and other people's help was reduced to the minimum. DISCUSSION The patient's functionality before injury, the duration and quality of rehabilitation after surgery, and the patient's motivation and cooperation during rehabilitation are the key factors of patient recovery to the pre-injury state. In spite of numerous concomitant diseases, reduced psychophysical abilities of the elderly and medical difficulties in the management of these injuries, such treatment of hip fractures is necessary and human for patients and time-consuming for medical staff, yet being the most profitable option for the society. Hip fracture and consequential disablement cause a double problem. On the one hand, it entails dependence on other person, family or social institution, or society in general, and on the other hand there is mental frustration, especially if he/she is psychically instable. Quite frequently, disabled persons have psychical traumas that have unfavorable impact on their families. It is additionally complicated in societies that tend to stigmatization of disabled persons. Therefore, it is very important how the society will behave toward disabled elderly who are generally more vulnerable.

The distortion of human pelvis X ray scans, due to different scanning positions, can cause huge mistakes in estimation of pelvic diameters. The aim of the study was to quantify distortion of pelvic diameters in relation to scanning inclination angles. Twenty anatomically defined spots on the pelvis of a young male cadaver, freed of soft tissues, were marked with 3 mm metal balls. The digitalized X-ray scans were made with seven different but similar inclination angles, and marked spots were recognized by computer software. Obstetrical-gynecological (Ob-Gyn), horizontal and vertical diameters were measured between marked spots, and percentages of distortion were calculated for each new scanning position. Twenty seven distances on human pelvis from seven X-ray scans varied from -35.9% to 28.3%, on average 0.47%. This study has pointed to a high variation of vertical pelvic dimensions (4.94 +/- 5.73%), consequently making them unreliable in the estimation of general pelvic shape, and low variation of horizontal dimensions (0.92 +/- 0.61%). Generally, the percentage of variation of pelvic dimensions highly increases with inclination angle, in frontal and sagittal plane. Alteration of scanning distance by 4 cm has a weak influence on pelvic diameters. The most reliable Ob-Gyn pelvic diameter was conjugata diagonalis, then diameters obliqua prima and secunda, with an average length deviations of 3.4, 4.0, and 6.0% respectively. The conjugata anatomica was the most unreliable with an average variation of 11.5%.