In 2013, 23.3% of the Swedish population of 9.7 million had foreign background and 15.4% were born outside the country. Immigrants, just as natives, suffer or will suffer from hip disease, which could involve surgery with total hip arthroplasty. Our aim was to explore the association between birthplace (in or outside Sweden), socio-economic factors and outcome after primary total hip arthroplasty. Records from the Swedish Hip Arthroplasty Register were cross-matched with population-based registers from the National Board of Health and Welfare and Statistics Sweden.  Preoperatively immigrants reported more problems with self-care (P≤0.02), usual activities (P≤0.05) and anxiety/depression (P≤0.005) as well as higher levels of pain. Postoperatively immigrants reported more problems in all EQ-5D dimensions. Improved patient information, better training of medical staff and better access to interpreters could facilitate these patients' contacts with health care and also contribute to improved outcome.

Background: Bosnia and Herzegovina became an independent state (6th April 1992) after referendum for the independence of Bosnia and Herzegovina which was held on 29 February and 1 March 1992. On the referendum voted total 2,073,568 voters (63.6% turnout) and 99.7% were in favor of independence, and 0.3% against. According to the provisions of the peace agreement, particularly in Annex IV of the Constitution of Bosnia and Herzegovina, the country continues to exist as an independent state. Like all others institutions, even the health-care system was separated between Federation and the other part of Bosnia and Herzegovina. The right to social and medical services in Bosnia and Herzegovina is realized entities level and regulated by entity laws on social and health-care. Aims: The aim was to explore how immigrants born in Bosnia and Herzegovina and living as refugees in their own country experience different institutions in Bosnia and Herzegovina with the special focus on the health-care system. We also investigated the mental health of those immigrants. Patients and Methods: Focus-group interviews, with 21 respondents born in Bosnia and Herzegovina and living as refugees in their own country, were carried out. Content analysis was used for interpretation of the data. Results: The analysis resulted in two categories: the health-care in pre-war period and the health-care system in post-war period. The health-care organization, insurance system, language differences, health-care professional’s attitude and corruption in health-care system were experienced as negative by all respondents. None of the participants saw a way out of this difficult situation and saw no glimmer of light in the tunnel. None of the participants could see any bright future in the health-care system. Conclusion: Health-care system should be adjusted according to the needs of both the local population born as well as the immigrants. Health-care professionals must be aware of the difficulties of living as immigrants in one’s own country. In order to provide health-care on a high level of quality, health-care professionals must meet all the expectations of the patients, and not to expect that patients should fulfil the expectations of the health-care professionals. Different educational activities, such as lectures, seminars and conferences, are needed with the purpose of the optimal use of the health-care system for people that have been forced to become refuges in their own country.

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.

Total Hip Arthroplasty (THA) aims to reduce pain and improve mobility, function and quality of life in patients with osteoarthritis, when non-surgical treatment has failed. Despite good or excellent results in the majority of patients, some of them are dissatisfied. This variability in outcome is multifactorial. Preoperative information, hospital care and postoperative rehabilitation may be more demanding if the patient is not familiar with the domestic language, belongs to a cultural minority or lives in poor socioeconomic circumstances. This thesis aimed to investigate the influence of ethnicity and socioeconomic factors on the outcome after primary THA. Demographic information and data relating the surgical procedure, patient reported outcome collected preoperatively and one year after the operation and any subsequent revision/reoperation were retrieved from the Swedish Hip Arthroplasty Register. Cross-matching with data from the Patient Register and Statistics Sweden was performed to retrieve information about comorbidities, cohabiting, education, and country of birth. Interviews and a self-administered questionnaire on given preoperative information, preand postoperative pain and patient satisfaction including the DASS 21 score for mental health of patients were also used. The interviews were analyzed using content analysis according to Graneheim and Lundman. The patients were analyzed in four groups (born in Sweden, the Nordic countries, Europe and outside Europe including the Soviet Union) or two groups (born in or outside Sweden). Patients from both groups in the qualitative study, expressed concern about inadequate pre-operative information on implants used, pain relief, choice of anaesthesia, no or too short a time to put questions to the surgeon and an overall stressful clinical situation. All the immigrant groups had more negative interference relating to self-care (p≤ 0.02), some immigrant groups tended to have more problems with their usual activities (p≤ 0.05) and patients from Europe and outside Europe more frequently reported problems with anxiety/depression (p≤ 0.005). Patients born abroad showed an overall tendency to report more pain on the VAS than patients born in Sweden. One year after the operation the immigrant groups reported lower values in all EQ-5D dimensions. After adjustment for covariates including the preoperative baseline value most of these differences remained apart from pain/discomfort and regarding immigrants from the Nordic countries, anxiety/depression as well. One year after the operation pain according to the VAS had decreased substantially in all groups. The immigrant groups indicated however more pain than those born in Sweden both before and after adjustment for covariates (p<0.001). Patients born outside Sweden had generally a poorer mental health than those born in Sweden. The risk of revision and reoperation within a period of two years did not differ between immigrants and patients born in Sweden. The difficulties for the patients born outside Sweden may depend on cultural differences, communication problems and differences in indications. This patient group could benefit from improved pre-and postoperative information and other measures to facilitate and improve their rehabilitation.

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).

Telemedicine itself is not the medical profession, it is not a medical specialty, but the way in which the medical profession conduct its activity. Therefore we are talking about tele otorhinolaryngology, tele cardiology or tele pathology. In the definition of a multitude of telemedicine that can be found in the literature is the following: Telemedicine is a system that supports the process of health care by providing ways and means for more efficient exchange of information that allows multitude of activities related to health care, including health care and health personnel, including education, administration and treatment. Telemedicine applications include tele diagnosis, tele consultation, tele monitoring, tele-care, tele consultations and remote access to information contained in one or more databases. It turned out that telemedicine is an important factor in technological, professional, financial and organizational uniformity of development of the health system. Telemedicine, although a new area, to a large extent already changed the ways of providing health care, and even more influence on the ways of designing the future of medicine.

Introduction: Records about the fractures of the distal humerus could be founds in the scriptures written long before Christ (Hippocrates 300 to 400 BC). During the twilight of science development and of any scientific work (the Middle Ages), little has been written about this problem. Between the 1700 and 1800 much was discussed about the controversies between the correct position and immobilization. In the early twentieth century view on the treatment of fractures of the distal humerus begins to change dramatically, from the former passive to active surgical treatment. The sudden turnaround followed thanks to the intensive development of technology, especially new imaging technology. Material and methods: We observed a period of 4 (four) years (1998 to 2002), and only hospital patients of certain age. As database are used the histories of the disease. The patients were followed for one year and at the same time, we analyzed (clinical) early complications after three (3) months and late complications (X ray), after a year. Among the early complications we observed most often lower motility and contraction, and of late we have followed the morphological deformation–cubitus varus and valgus. Results: Using x-ray images, we measured Baumann’s (en face) and lateral condylar angle (profile) after one year in the operated group and the group treated conservatively SPDH type III in children. We calculated the arithmetic mean (x) and a standard deviation (SD) in both groups. Using chi square and t–test, with the probability of 95%, we showed that there is a significant difference between operative and conservative treatment of SPDH type-III in children, according to Gartland. Conclusion: All humerus fracture type-III by Gartland in children should be surgically treated. Surgery should be undertaken in a time frame of 6 hours. Surgery should be done in these cases by the specialized institutions (Clinical Hospital Centre). The success of treatment in such institutions corresponds to the results achieved in the world (93.0%). We must be sure to adopt and implement a scheme of treatment of fractures of the distal humerus in children. Required is faint trail, OPF, lateral (Kaplan) approach, exceptionally for some articular fractures posterior approach by Campbell, fixation with two or more Kirchner’s needles, usually cross-set at an angle of 30°, vacuum drainage with cast immobilization.

Background and purpose — Some patients have persistent symptoms after total hip arthroplsty (THA). We investigated whether the proportions of inferior clinical results after total hip arthroplasty—according to the 5 dimensions in the EQ-5D form, and pain and satisfaction according to a visual analog scale (VAS)—are the same in immigrants to Sweden as observed in those born in Sweden. Methods — Records of total hip arthroplasties performed between 1992 and 2007 were retrieved from the Swedish Hip Arthroplasty Register (SHAR) and cross-matched with data from the National Board of Health and Welfare and also Statistics, Sweden. 18,791 operations (1,451 in immigrants, 7.7%) were eligible for analysis. Logistic and linear regression models including age, sex, diagnosis, type of fixation, comorbidity, surgical approach, marital status, and education level were analyzed. Outcomes were the 5 dimensions in EQ-5D, EQ-VAS, VAS pain, and VAS satisfaction. Preoperative data and data from 1 year postoperatively were studied. Results — Preoperatively (and after inclusion of covariates in the regression models), all immigrant groups had more negative interference concerning self-care. Immigrants from the Nordic countries outside Sweden and Europe tended to have more problems with their usual activities and patients from Europe and outside Europe more often reported problems with anxiety/depression. Patients born abroad showed an overall tendency to report more pain on the VAS than patients born in Sweden. After the operation, the immigrant groups reported more problems in all the EQ-5D dimensions. After adjustment for covariates including the preoperative baseline value, most of these differences remained except for pain/discomfort and—concerning immigrants from the Nordic countries—also anxiety/depression. After the operation, pain according to VAS had decreased substantially in all groups. The immigrant groups indicated more pain than those born in Sweden, both before and after adjustment for covariates. Conclusion — The frequency of patients who reported moderate to severe problems, both before and 1 year after the operation, differed for most of the dimensions in EQ-5D between patients born in Sweden and those born outside Sweden.

Introduction: Fractures of the proximal femur and hip are relatively common injuries in adults and common source of morbidity and mortality among the elderly. Many methods have been recommended for the treatment of intertrochanteric fractures. Material and methods: We retrospective analyzed all the patients with fractures of the hip treated with proximal femoral nail antirotation (PFNA) at the Clinic of Orthopedic and Traumatology, University Clinical Centre Tuzla from the first of January 2012 to 31 December 2012 years. The study included 63 patients averaged 73.6±11.9 years (range, 29 to 88 years). Fracture type was classified as intertrochanteric (Arbeitsgemeinschaft für Osteosynthesefragen classification 31.A.1, A.2 and A.3) and subtrochanteric fractures (Seinsheimer classification). Results and discussion: The ratio between the genders female-male was 1.6:1. There was statistically significant difference prevalence of female compared to male patients (p=0.012). There were 31 left and 32 right hip fractured. Low energy trauma was the cause of fractures in 57(90.5%) patients. Averaged waiting time for hospitalization was 3.2±7.5 days (range, 0 to 32 days). 44 patients were admitted the same day upon injuring. The average waiting time for the treatment was 3.6±5.7 days. The ratio between with or without co-existent disease was 4.7:1. During the three months postoperatively with ASA score 3 and 4 six patients died. There were no significant differences in deaths from ASA score 1 and 2 (p=0.52). Reoperation for the treatment of implant or fracture-related complications was required in three (4.7%) patients (infection, reimplantation and extraction). Three patient developed deep vein thrombosis. Statistically significant difference was found in the deaths in the first three months compared to the next three months (p=0.02). We found statistically significant difference between pre-injury and postoperative mobility score (p=0.0001). Conclusion: PFNA is an excellent device for osteosynthesis as it can be easily inserted. Moreover, it provides stable fixation, which allows early full weightbearing mobilization of the patient.

Background: We aimed to explore the background of refugees emigrating to Sweden and their situation in the new country with special focus on their contacts with the Swedish healthcare system. Material and methods: Our study has a qualitative design. Data was collected between January and October 2013 during face-to-face interviews using open-ended questions. A qualitative content analysis was carried out in accordance with the Graneheim and Lundman method (2004). The participants were 8 women and 7 men, aged between 65 and 86 years who had emigrated from Bosnia and Herzegovina. They had lived in Sweden between 13 and 21 years. Results: The findings revealed that the participants themselves experienced that change of scenery, culture and language influenced their own well-being. The most important finding was that language and communication difficulties are experienced as the major problems. These difficulties implied that all informants were forced to seek help from their children or to use an interpreter when they visited various healthcare institutions. Conclusions: Health care professionals need to be aware of the diverse needs of various ethnic groups in Sweden, some of whom may carry traumatic experiences that could influence their health. In order to provide trans cultural care, a professional staff needs to know that historical, political and socioeconomic factors may influence ethnic minorities. Health care staff needs to recognize that social problems might be medicalized. In particular this article emphasizes the problems associated with language.