Obesity is risk-factor for the most common nowdays diseases, as cardiovascular diseases, diabetes, hypertension, some carcinomas, degenerative diseases of weight bearing joints (spine, hips, knees), and present a huge medical and social problem, as well. It causes not only somatic but mental problems as well, especially in females and younger persons. Some of them undergo risky weight reducing methods, surgical procedures, etc, to reduce their body weight and to release mentally stressing body deformities. Aim of the work is to quantify negative impaction of obesity on functionality of the knee, the key joint in everyday body activities (rising, standing, walking, and climbing). Study has analyzed 22 randomly chosen patients (5 male, 17 female) with strong degenerative alteration of the knee (osteoarthritis), who were treated on the Department for orthopedic and traumatology, Clinical center Sarajevo during 2005 and 2006. Average age was 63.6 +/- 10.6 (54-76) years, with Body Mass Index (level of obesity) 31.1 +/- 3.5 (27-38) points, and average duration of symptoms 9.1 +/- 7.4 (1-25) years. The knee functionality was assessed by Knee Society Knee Score (KSKS). Completely healthy knee has 200 points--50 points for pain free knee, 25 points for stabile knee, and forfull extension-flexion arch, both, 50 points for normal walking and stairs climbing, both. Average value of KSKS was 118.1 +/- 35.0 points. As it was expected, there were strong significant correlation between KSKS and age (r = -0.50, p = 0.015). The duration of disability correlated with KSKS (r = -0.5, p = 0.02), and level of pain (r = 0.60, p=0.00). The obesity has significantly increased level of pain in the knee (r = -0.44, p = 0.04), all patients were obese persons. Persons with reduced functional abilities avoid body activity, it causes increasing of obesity, and one makes other worse. Concerning on incidence of described problem and its impaction on society in general, it is necessary to make every effort in prevention and treatment of obesity, as important risk factor and consequence of reduced functional abilities and risk factor of most common nowadays diseases.

The aim of this study was to recognize differences in midterm clinical outcome after femoral neck fracture and hip endoprosthesis implantation. A 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 can be concluded that the choice of endoprosthesis does not pose an obstacle to a patient’s recovery.

Osteosinthesis of femoral neck fractures achieves higher stability of fragments but additionally destroys weak vascular elements of femoral neck. Aim of this study is to analyze relation between different treatment options of impacted femoral neck fracture and avascular necrosis of femoral head. In retrospective analysis we have retrieved data from 1632 patients who were treated at the Department for traumatology, Clinical center Ljubljana in period Jan/87 - Dec/01. Impacted femoral neck fracture was found in 365 patients (22.4%). We have selected only patients with follow up period longer then half year and finally there were only 94 patients included in study. Analyzing incidence of avascular necrosis, dislocation of fragments, and pseudoarthrosis in non-operatively and surgically treated groups of patients by lambda2 (0.305), we have concluded that there is no relation between avascular necrosis and way of treatment of impacted femoral neck fracture.

The aim of this study is to mathematically approximate the shape of the femoral articulating line and compare radiuses of condylar curves within and between males and females. Ten male and ten female participants 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. Average radiuses of condylar curves were between 4.5 and 1.7 cm medially, and between 3.2 and 1.8 cm laterally, for 0 degrees and 90 degrees flexion contact point respectively. Males had longer curve radiuses of both condyles (p < 0.05). Differences turned out to be statistically insignificant after adjusting to body height. Even small changes in the joint geometry during lifetime could make a joint susceptible to osteoarthritis or injuries. Approximation of the radiuses of femoral condyle curves is a useful method in anthropometric, radiological and virtual calculations of the knee geometry, and other ellipsoidal structures in human body, like wrist, scull segments, dental arches, etc.

We compared kinetic characteristic of unipolar, bipolar and total hip endoprostheses, implanted after dislocated femoral neck fracture. Ninety patients were divided into three groups (30 patients in each group); a group with unipolar partial hip endoprosthesis (UPEP), a group with bipolar partial hip endoprosthesis (BPEP) and a group with total hip endoprosthesis (TEP). The patients from different groups were paired by parameters which could influence the long term functional result: follow up period, comorbidities, functional capabilities before injury, etc. After the average follow up 3.8 +/- 1.9 years, a measuring of range of hip motions (ROM) was conducted. The largest mean amplitudes in flexion (104 degrees), extension (13 degrees), abduction (35 degrees) and external rotation (38 degrees) was achieved BPEP, the largest adduction (14 degrees) was achieved UPEP, and internal rotation (34 degrees) TEP. Differences in ROMs are partially related to the clinical parameters such as: level of the hip pain, gait pattern, age and rehabilitation period (P < 0.05). Measuring of ROMs is the most reliable part of the clinical exam and it does not depend on subjectivity of patient, as opposed to other clinical parameters (level of pain, walking distance, aids usage, etc). The results obtained are favorable for the bipolar hip endoprosthesis, and they can be related to the biomechanical differences between the three types of hip endoprostheses. Kinetic advantages of the BPEP as compared to the UPEP, can be explained by the BPEP's structure: two-level mobility and a thinner neck which delays impingement in the late motion phase. In comparison to the TEP, clinical advantages of the BPEP can be attributed to less extensive surgery and scarring.

AIM To analyze anatomic and kinematic characteristics of male and female knees in the sagittal plane. METHODS Ten healthy male and 10 healthy female participants performed extension of their right lower leg in non-weight bearing and weight bearing conditions. The centers of knee joint motion were obtained by videographic motion analysis, and radii of condylar curves were calculated from digitalized X-ray scan. The Knee Roll software was made for this purpose. RESULTS The extension of the knee in non-weight loaded and weight loaded conditions is a combination of rolling and sliding joint surface motion with 6:5 ratio, in both genders. During the last 20 degrees of the extension of weight loaded male knee, rolling/sliding ratio changed to 8:1 (P<0.05). Average radii of condylar curves were between 4.5 and 1.7 cm medially, and between 3.2 and 1.8 cm laterally, for 0 degrees and 90 degrees flexion contact point, respectively. Gender differences in the radii of condylar curves, after the adjusting to body height were insignificant. CONCLUSION A higher proportion of joint surface sliding with consecutive anterior tibial displacement in women indicates more strain during knee extension, potentially making the female anterior cruciate ligament tend and susceptible to injury. The gender differences in the knee kinematics are probably the consequence of different soft tissue structure or its activity, because no difference in the sagittal shape of femoral condyles was noted.

Due to osteoporosis and incoordination, elderly people are prone to hip fractures. Hip endoprosthesis is the most rational treatment of such injuries at persons older that 65 years of age. Aim of our work was to analyze long term clinical result at the elderly patients with implanted unipolar partial hip endoprothesis after femoral neck fracture. Inclusion criteria were implantation of unipolar partial hip endoprothesis as the first operative procedure and absence of changes visible an X-ray. Our follow up was at least 18 months and all patients were treated between January 1996 and June 2001 at the Clinic for Orthopedics and Traumatology in Sarajevo according to department protocol. We used Harris hip score (HHS) for clinical evaluation. From basic group of 131 patients, in retroprospective prospective research with average follow up period of 40 months, 32 patients were clinically examined, others passed away or were not reachable. Life expectancy in basic group was 3.5 years and average HHS in examined group was 72,06 points. Our study showed that unipolar partial hip endoprothesis implanted after femoral neck fracture achieves long term fair clinical result. Main factor on a patient's recovery is not type of implanted hip endoprothesis, but general health condition before injury, motivation and early postoperative mobilization.

We present case of a 13 y. girl who has admitted with hard symptoms on our Department after back injury in school. Clinical presentation and complete radiological tests were pointed to inflammatory process of sacroiliac region. Hard general condition has forced us to indicate operative procedure. Diagnosis was established after surgical intervention-incapsulated tumor-lipoma, which has been extirpated without visible inflammatory signs. After this intervention local and general condition were improved-clinically and laboratory. Girl was sent to home as a completely cured patient.

We present patients (both sex) with open fractures of tibia of the second and third degrees. All patients were wounded during the four years of military actions around Sarajevo (1992±1996) and treated at the Clinic for orthopaedics and traumatology in Sarajevo under war circumstances. We identify complications of such wounds and point to work performed under extremely hard conditions for orthopaedic and traumatologic surgeons and other medical stuff.

Injuries caused by pressure activated explosive devices are very complex medical and social problem in Bosnia and Herzegovina. Hindfoot injuries are also a big challenge for orthopedic surgeons concerning all forthcoming physical assessment of the patients and the fact that the forefoot and midfoot remain preserved. The study included 60 patients with amputation that followed such an injury, and 60 patients treated with reconstructive procedures. The gait of the patients was assessed in the period of 4 years. In 20 patients, destroyed tissues were sent referred for pathohistologic examination, which revealed typical signs of a damage caused by high kinetic energy devices. The gait was analyzed objectively by the examiner and subjectively by the patients, which was the main indicator of successful treatment. Infection analysis and plantogram were also taken into account. The study showed that in a number of cases primary reconstruction of the hindfoot injuries caused by pressure activated explosive devices was possible with satisfactory results, thus foot amputation having strict indication. Indications for amputation have been limited and foot preservation has become more real in the majority of patients.

The most common and dangerous operative complication after procedure hip joint replacement in orthopaedic surgery is plumonary embolysm. In our work we compare frequency of tromboembolic complications in group which was under suggested profilaxa and in other group with no such profilaxa. Importance of this work is not in a reducing of such complications but also in accepting of unique, wide excepted and scientific based protocol of postoperative tromboembolic profilaxa in ou country.