Sir, We read with interest this article in the March 2005 issue by Angliss et al[1][1] entitled ‘Surgical treatment of late developmental displacement of the hip: results after 33 years’ and would like to congratulate the authors upon their excellent results. We consider iliopsoas to be a key

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.

UNLABELLED Infant walkers are mobile wheeled seats that allow infants to move around with their feet on the floor. They enable precocious locomotion in very young, otherwise prelocomotor infants. Prelocomotor walker experience prevents visual access to the moving limbs. Infant walker use can be associated with delay in achievement of normal locomotor milestones. Besides delayed motor development, contractures of the calf muscles and motor development mimicking spastic diparesis may appear. In the case of infant walker's use for the infants at risk for development of cerebral palsy, multiple side effects can be produced: the persistence of positive support reflex, heel cord contractures, subluxation and dislocation of the hips or pronation contractures of the upper extremities. The use of infant walkers increases the risk of injuries. The study has enrolled 150 children and their mothers, from three big cities in Bosnia and Herzegovina (Sarajevo, Bihać, Zenica). All relevant data have been collected through the questionnaires. 130 children (86.6%) have used infant walkers. The mean age when the use of infant walker has started was 7 months. The mean time of daily use of infant walker was 1 hour 49 minutes. Twenty three children had various motor disturbances, 13 out of them (56.5%) have used infant walker. The mild injuries caused by using the infant walkers have been registered in 17 cases (11.3%). 83 mothers (55.3%) were aware of infant walker's nocuous effects. CONCLUSION The use of infant walkers has been spread widely under our circumstances. There is significant discrepancy between mothers' knowledge about nocuous effects of infant walkers and their practice. The use of infant walkers for infants with motor disturbances is especially harmful. The main reason for using infant walker, despite of its harmfulness, was mother's preoccupation with everyday household activities. It is necessary to engage health professionals to support antiwalker campaign (warning labels on the infant walkers, public education programs, etc). We recommend safer alternatives for child daycare, like stationary activity centers (so called "fenced play gardens".

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.

Cancers of rectum and anus are among most frequent cancers with a tendency of increasing frequency. According to available data, the percentage of surgeries performed during period 1973-1977 was 61%, and during period 1991-1993 78%. From those data it can be seen that the frequency of performed surgical treatments is evidently increasing lately. High percentage of patients suffer from the process that is involving neighbouring organs and tissues, therefore declared as inoperable. In this study we present five cases with malignant tumors of pelvis who were treated during period 1990-2002 with mutilating surgical technique--chemipelvectomy. In all surgical procedures we have used King's and Steelquist's methods. At the same time, these surgical procedures are moving the limits of tumors' inoperability. The survival period for 4 patients was over one year, and 1 patient died due to postoperative embolism. In 1 patient, the wound has healed per secundam. We registered no cases of local recurrence. The new possibilities in the treatment of pelvic tumors which are often declared as inoperable are opened due to the fact that chemipelvectomy is moving the limits of so-called inoperable types of tumors. We believe that it is necessary to open new discussions on this issue because the coming time will offer new possibilities in the surgical treatment of pelvic tumors.

Malignant tumours are important health problems today. In most countries they are second cause of death in general population. In this work it was presented epidemiology of rectal cancer which are treated in Abdominal Surgery Department at University Clinical Center in Sarajevo of Bosnia and Herzegovina. This is only part of complete investigation of incidence malignants in Bosnia and Herzegovina. Our study is a retrospective and observation two five years periods. First is between 1987.g. and 1991.g., and second is between 1996 and 2001.g. During first period in Abdominal Surgery Department, we had 668 cases of abdominal malignant and 225 of these cases were carcinoma colorecti. In the second period we had 831 cases of abdominal malignant and 311 of these cases were carcinoma colorecti. When we compared our data with other referents from East Europe, we can say that the results mostly the same, and when we compared first five years period (1987-1991), with second five years period (1996-2001), there are also no statistically significant increase.

In the work we have examined 44 patients (16 women and 28 men), which the break of distal humerus is saned with operation, using adequate OSM. The average years of women patients was 29 (from 3 to 79), and of male patients 24 (from 1 to 75). After thr operative sanitary breaks distal part of humerus, using adequate OSM (fillo Kurschneri, platho metalico, clavo spiralis), it can come on lesion of perifer nerves of the arm, and mostly of n. radialis. Lesions of n. radialis we have notice on 5 patients. The rehabilitation our patients was made with prevention contraction of shoulder, elbow, hand and fingers using kinesitherapy, hydrotherapy and electrotherapy paralysis musculature with intentional exercises to the reinervation of perifer motor neuron and raising the force of musculus.

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.

AIM To present the results of medial approach in open reduction of congenital hip dislocation, with the preservation of the medial femoral circumflex artery. METHODS We operated on 48 nonreducible hip dislocations diagnosed in children aged 6-27 months. Twenty-two hips (17 patients) were available for clinical and radiographic follow-up. The median age of children at the time of operation was 15 months (range 7-29), and median duration of the follow-up was 4.5 years (range 3-14). The latest radiographic evaluation of the treatment outcome was based on Severins classification. RESULTS There were three hips with the loss of concentric reduction. Osteochondritis developed in three, and coxa magna in seven hips. On final evaluation, 19 hips were rated as excellent or good (Severin I or II), and three hips as poor (Severin III or IV): one hip with evident ostechondritis lesions, and two hips with the loss of concentric reduction due to treatment discontinuation. CONCLUSION By preserving circumflex medial artery and eliminating obstacles to reduction, vascularization of the femur head is ensured. The loss of concentric reduction is prevented by complete removal of all obstacles on the way of the femur head down to the bottom of acetabulum, by postoperative cast immobilization, and by walking with abduction orthosis for an appropriate period of time. Medial approach in surgical management of congenital hip dislocation in infants under 24 months of age is considered safe and efficient procedure.

Diaphyseal femoral fractures at children is very common, especially during the children play, traffic accidents and others. In spite on the dramatic clinical status (severe pain, deformity, pathological motions, and loss of stability) and great dislocation, conservative treatment almost always have good clinical result. Basis of this treatment is 3 week of indirect traction and after 6 weeks of plaster cast immobilization with permanent clinical and radiological evaluations. Operative treatment is reserved for cases of unsuccessfull conservative treatment and its complications. Resistutio ad integrum is almost always complete, thanks to good quality of this method, good biological potential of the child bone and good rehabilitation after immobilization.

BACKGROUND Recent vascular studies suggests that patients with arterial occlusive disease (AOD) and with elevated score of multiple risk factors (MRF), especially diabetes mellitus, have an increased prevalence of critical limb ischaemia, increased incidence of lower limb amputations, and an overall poor outcome of their AOD. The aim of this study is to evaluate an overall outcome of AOD, Fontaine stage III and IV, and to correlate their outcome with score of MRF. METHODS We enrolled a group of 136 patients (99 males and 37 females), with an average of 63.7 yrs and SD 12.2 all with AOD, Fontaine stage III and IV. We divided pts in three groups--pts on medicament treatment--MT group, pts for lower limb amputation--AMP group, and pts for vascular surgery. According to their clinical stage we had group in Fontaine stage III (n-48), and Fontaine IV (n-88). We followed 9 clinical variables: age, gender, tobacco, arterial hypertension, diabetes mellitus, hyperlipidaemia, level of fibrinogen, coronary ischaemic disease and cerebrovascular disease. RESULTS In MT group we had n-91 (66.9%) with MRF score of 3.42. In Fontaine stage III we had 37 pts with MRF score of 3.89, and in Fontaine stage IV we had 54 pts with MRF score of 3.37. In AMP group we had n-23 pts (16.9%) with MRF score of 3.39, and all pts were in F IV stage. In VH group we had n-22 pts (16.1%) with MRF score of 3.1. In VH group 50% of pts were in F IV stage. In overall group (n-136) we had a significant number of Fontaine IV stage pts, p < 0.01. CONCLUSIONS We had a high risk group of patients, with mean MRF score of 3.42, 23 pts (16.9%) were referred for lower limb amputation, and 23 pts (16.9%) for vascular surgery. MRF score correlate with overall outcome of AOD, r = 0.72, p < 0.001.

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.

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.