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.

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.

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.

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 Previous studies have documented ethnic differences in the utilization of total hip arthroplasty. Less is known if this operation is performed at the same stage of symptoms and has equal effects in patients with different ethnicity. AIM We investigated whether patients born outside Sweden report equal effects of operation with the insertion of a total hip replacement in terms of EQ-5D, pain and overall satisfaction as those born in Sweden. METHOD Preoperative and 1-year postoperative data from Swedish Hip Arthroplasty Register, (1216 patients,1216 hips) with primary osteoarthritis of the hip operated between years 2002 and 2006, were analysed. All patients completed the EQ-5D form, filled in a VAS about pain preoperatively and at 1 year postoperatively, when a VAS about overall satisfaction was added. FINDINGS Before the operation and after adjustment for confounders, patients born abroad reported more problems (dichotomized into no or moderate/severe problems), with self-care (p = 0.01) and anxiety/depression (p = 0.02) in the EQ-5D form than those born in Sweden. They also had more pain (VAS, p = 0.04). One year after the operation and after statistical adjustments, patients born outside Sweden reported lower scores for self-care (p = 0.008) and usual activities (p = 0.001) in the EQ-5D form. They still reported more pain (VAS, p = 0.02), but no significant difference concerning degree of satisfaction (p = 0.3). CONCLUSIONS Our finding of more preoperative disability and pain (VAS) before the operation in patients born abroad might depend on cultural differences, communication problems and differences in indications. Even if the effect of the total hip replacement was good, patients born abroad scored less for some of the items at 1 year. We think that this patient group could benefit from improved pre- and postoperative information and other measures to facilitate and improve their rehabilitation.

Background and purpose Total Hip Replacement (THA) is one of the most successful and cost-effective operations. Despite its benefits, marked ethnic differences in the utilization of THA are well documented. However, very little has been published on the influence of ethnicity on outcome. We investigate whether the outcome—in terms of reoperation within 2 years or revision up to 14 years after the primary operation—varies depending on ethnic background. Methods Records of total hip arthroplasties performed between 1992 and 2007 were retrieved from the Swedish Hip Arthropalsty Registry and integrated with data on ethnicity of patients from 2 demographical databases (i.e. Patient Register and Statistics Sweden). The first operated side in patients with THA recorded in the Swedish Hip Arthroplasty Register (SHAR) between 1992 and 2007 were generally included. We excluded patients with 1 Swedish and 1 non-Swedish parent and patients born abroad with 2 Swedish parents. After these exclusions 151,838 patients were left for analysis. There were 11,539 Swedish patients born outside Sweden. We used a Cox regression model including age, sex, diagnosis, type of fixation, whether or not there was comorbidity according to Elixhauser or not, marital status and educational level. Results The mean age was lowest in the group of patient coming from outside Europe including the former Soviet Union (61 years), and highest in the Swedish population (70 years). Before adjustment, for covariates, patients born in Europe outside the Nordic countries showed a lower risk to undergo early reoperation (HR = 0.73, 95% CI: 0.56–0.97), which increased after adjustment to (HR = 0.76, 95% CI: 0.58–1.01). Before adjustment, patients born in the Nordic countries outside Sweden and those born outside Europe (including the former Soviet Union) showed a higher risk to undergo revision than patients born in Sweden (HR = 1.14, 95% CI: 1.02–1.27; HR = 1.49, 95% CI: 1.2–1.9), but this difference disappeared after adjustment for covariates. Conclusion We did not find any certain differences in reoperation within 2 years, or revision within 14 years, between patients born in Sweden and immigrants. Further studies are needed to determine whether our observations are biased by the attitude of health providers regarding performance of these procedures, or by a reluctance of certain patient groups to seek medical attention should any complications requiring reoperation or revision occur.

Ferid Krupic 1,3, Sylvia Määttä2, Göran Garellick 1,3, Elisabeth Dahlborg Lyckhage2,4, Johan Kärrholm 1,3 Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden1 The Centre for Gender Equal Care, Västra Götalandsregionen, Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden2 The Swedish Hip Arthroplasty Register, Registercentrum VGR, SE-413 43, Gothenburg, Sweden3 Institute of Nursing, University of West, Trollhatatan, Sweden4

BACKGROUND Total hip replacement is an operation that usually leads to pain relief and improved health related quality of life (HRQoL). Previous studies have demonstrated the importance of information about upcoming surgery. Therefore, it was of interest to study how both immigrants, whose first language was not Swedish, and Swedish patients described pre-operative information. MATERIAL AND METHODS Individual interviews were conducted with 10 immigrants and 10 Swedish participants. The data were analysed using qualitative content analysis. The study was carried out in western Sweden from March to November 2010. RESULTS The findings revealed that pre-operative information for all patients undergoing elective total hip replacement was limited. Patients from both groups expressed concern about inadequate preoperative information pertaining to the surgery, implant selection, pain relief, choice of anaesthesia, no or too short a time to put questions to the surgeon and an overall stressful situation. CONCLUSIONS Adequate preoperative information is important for optimising pain relief and shortening the hospital stay. The fact that the patients overwhelmingly rated the preoperative information as inadequate may be due to several reasons. Mental distress and the two-week interval between the time when the patient received the information and the operation might have contributed to the low degree of retention.