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Introduction: Osteoarthritis (OA) or arthrosis represents an inflammatory disease of joints that develops as a result of interaction of mechanical and biological parameters. With disease development, degenerative changes on joint cartilage can be noticeable that affect and cause pathological changes on other parts of a joint resulting in pain and dysfunction of a joint. A. E. Garrod in 1907 described osteoarthritis as a special clinical entity and separated it from a rheumatoid arthritis. OA is characterized with loss of a joint cartilage, development of new bone tissue under affected cartilage (subchondral bone) and development of osteophytes on joint edge. First sign of a disease is pain after period of relaxation that slowly intensifies., Material and Methods: In this paper, 40 patients have been analyzed with clinical and radiological signs of OA of the knee joint. Radiological classification was done by Ahlback's classification., Results: In our study female gender was more affected with average age of 63 years. On Ahlback classification, grade II was represented the most. Comparison between clinical and radiological signs showed that there was no significant difference between established grade of OA. Wide spectrum of visible radiological osteoarthritis changes on joints is in correlation with the age of examinees., Competing Interests: • Conflict of interest: none declared.

Introduction: Supracondylar humerus fractures are the most common fractures of the humerus at the elbow in children. The key role belongs to the age and immaturity of the humerus region. Treatment, even today represents the problem of bone and joint surgery. Gartland classification divides these fractures into four types. Analysis of radiographic parameters will serve as an indicator for treatment selection., Goal: To demonstrate the role of radiographic evaluation by measurement of default radiographic parameters and indicate the choice of treatment for supracondylar fractures of type I and II by Gartland., Material and Methods: The study included 60 children aged 4-14 years, divided into two groups, first with initial radiographic analysis and the second one without radiographic analysis. All were treated at the Primary Health Care Center Novi Travnik and Nova Bila Hospital from 2009 to 2011. Analysis was performed using methods of descriptive statistics to calculate the mean and standard deviation, Student's t-test and Chi-square test., Results: In patients from first group hospitalization, immobilization duration, as well as physical treatment was shorter and more frequently surgical treatment was applied (manual reduction with K-wire fixation) with statistically significant difference (p = 0.042)., Conclusion: Radiographic evaluation is one way to choose methods of fracture treatment. The incidence of complications is low, with excellent outcome of treatment and a faster return of children to their daily activities.

Introduction: Emergency medicine is a new academic discipline, as well as a recent independent clinical specialization with the specific principles of practice, education and research. It is also a very important segment of the overall health care and health system. Emergency medicine as a distinct specialty was introduced in the U.S. in 1970. Ten years later and relatively quickly emergency medicine was introduced in the health system in Bosnia and Herzegovina as a specialty with a special education program for specialist and a final exam., Goal: Compare the development of emergency medicine in Bosnia and Herzegovina with the trends of development of this discipline in the world as a specialization and an academic discipline. Identify specific problems and possible solutions and learn lessons from other countries., Methods: Reviewed are the literature data on the development of emergency medicine in the world, programs of undergraduate and postgraduate teaching, the organizational scheme of emergency centers and residency. This is then compared with data of the current status of emergency medicine as an academic discipline and a recognized specialization, in Bosnia and Herzegovina., Results: There are substantial differences in the development of emergency medicine in the United States, European Union and Bosnia and Herzegovina. Although Bosnia and Herzegovina relatively early recognized specialty of emergency medicine in academia, it failed to mach the academic progress with the practical implementation. A&E departments in the Community Health Centers failed to meet the desired objectives even though they were led by specialists in emergency medicine. The main reason being the lack of space and equipment as well as staff needed to meet set standards of good clinical practice, education and research. Furthermore the Curriculum of undergraduate education and specialization does not match modern concept of educational programs that meet the principles set out in emergency medicine and learning through practice., Conclusion: The Development of emergency medicine as a separate specialization and independent academic discipline has had different way and pace of development, and there is no ideal model that can be applied in all countries. However experiences from countries with well developed emergency medicine, suggest that the model of the simultaneous development of emergency medicine as a distinct academic discipline on independent recognized residencies with a strong national association is the best way for the formation of an efficient health system. The establishment of Emergency centers--departments for emergency medicine at university and cantonal hospitals, introduction of emergency medicine as an academic discipline, implementation of specific post-graduate teaching and continuing medical education through appropriate courses, as well as academic development program for the teaching staff is the most important element of future development of this discipline. It would also contribute to it achieving the appropriate status in both the academic institutions and in practice within the health system of Bosnia and Herzegovina.

Unlabelled: Stroke is a clinical syndrome characterized by the sudden occurrence of a permanent focal neurological deficit. The most common causes of death are transtentorial herniation, pneumonia, pulmonary embolism and heart disease. According to literature data, pulmonary embolism (PE) is responsible for 5% of deaths after stroke., Aim: The aim of this article is to determine the incidence of patients who had secondary vascular complications in the form of PE and deep venous thrombosis (DVT) after stroke and indicate the need for creating and promoting the algorithm for these complications in patients after stroke., Material and Methods: The study included 86 patients hospitalized at the Clinic of Physical Medicine and Rehabilitation in the period from October 2008 to October 2009 who have had rehabilitation as a continuation of the treatment immediately after the stroke., Results: Hemorrhagic type was present in 13% of patients, and ischemic in 87%. As a secondary complication after stroke, five patients had pulmonary embolism. Neurological deficit in these patients was in the form of hemiplegia and were with ischemic type. Time from stroke until the appearance of symptoms of pulmonary embolism was in average 25.4 days. Suggested thrombi prophylaxis therapy (which they received before rehabilitation) in patients who have developed PE was Aspirin Protect, while no patient had recommended low molecular heparin. Physical therapy was performed for all patients, and mechanical methods of prophylaxis were used., Conclusion: Different attitudes about prophylaxis effects for these patients should be regulated by a unique algorithm that would reduce the possibility of discrepancy in therapeutic sense. That is why for patients with acute stroke and limited mobility it is recommended to use heparin or low molecular heparin (LMH) in preventive doses, if there are no contraindications for anticoagulants, with physical therapy and mechanical methods of prophylaxis.

The treatment of patient with relapse of bleeding after application of minimally invasive treatment of hemorrhoidal disease such as elastic band ligation, cryosurgical treatment Hemorrhoidal Arterial Ligation (HAL) can be presented as serious clinical problem in patients with concomitant diseases that can be contraindication for radical surgical treatment. We compared the Simple Digital Method and standard above mentioned minimally invasive ambulatory treatment. We used special proctoscope with Doppler Flowmeter in order to identify all branches of hemorrhoidal artery in the anal canal creating graphical presentation using specially adapted software. HAL method is then used to perform ligation of hemorrhoidal artery branches. The elastic ligatures (called gummiligatures) are then applied to the piles in which most prominent flow was registered using Doppler Flowmeter. Antibiotic prophylaxis and sedation was administered preoperatively. Special computer program registered all steps. Hemorrhoidal ointments and paracetamol were used after surgical procedure. Average number of identified hemorrhoid arteries branches was six, and total duration of the procedure was in average 28 min. We compared patient treatment with our method and standard methods. In tested group we noticed significantly fewer complications (after eight days the number of complications 11% vs. 74%, p<0.001, after 15 days 3% vs. 11%: p=0.101). One year after procedure, the treatment was successful in 91.4%, or 32 out of 35 patients according to proctoscopy and Doppler Flowmeter exam. There were three patients with relapse of symptoms. In 77% of patients hat were treated with rubber bands ligation relapse occurred. Our method is significantly more successful in comparison to classical methods of ambulatory treatment and can be alternative to radical surgical treatment.

One of the most common events in Surgical Ward is admission of patients with biliary tract disease. To evaluate such patients, it is necessary to create appropriate database and define attributes that will be analyzed. The patients should be divided in groups for analysis and data processing. There were 219 patients included in the study. All patients were selected on the basis of ICD-10 codes and then divided into categories according to the code. In order to assess selected patients, the database was created with all relevant questions about anamnesis, diagnostic tests and surgical procedures. The data about patients was entered into the database. It is possible to analyze data about the most frequent disorders of biliary tract. The most common entity was chronic cholecystitis with calculus and most common procedure was laparoscopic cholecystectomy. The other important attributes are also assessed. ICD-10 classification can be used as a basis for aggregation of data of the patients with biliary tract disease. Some of the codes are more frequent than others and some are rarely used.

Introduction: the lower extremity requires an understanding of the ways in which such reconstruction differs from that of the upper extremity. The weight-bearing requirements are the most obvious difference. The difference between the cutaneous coverage on the plantar surface on the foot and that on the dorsum has important implication for reconstruction of defects in these areas. There are few operative techniques for reconstruction of the posttraumatic heel defects, in our study we have been compared two techniques, free microvascular flap and reverse supramaleolar fasciocutaneous flap., Aim: the aim of the study is evaluation of the appearance of stress ulcers as late complications of the heel reconstruction, comparing these two methods., Material and Methods: in testing were included 50 patients with posttraumatic heel defects, of different etiology, divided in two groups. The first group of 25 patients with posttraumatic heel defects has been treated by microvascular free flap. The other group of 25 patients with posttraumatic heel defects has been treated by reverse supramaleolar fasciocutaneous flap., Discussion: according to our results, there are significant differences between proportions of patients with and without of late complications of free microvascular flap comparing with reverse supramaleolar fasciocutaneous flap., Conclusion: stress ulcers, as result of continuous pressure on weight-bearing area, have been evaluated by using both operative methods. Reverse supramaleolar fasciocutaneous flap is good alternative method for heel reconstruction.

Authors present own experience after use surgical correction technique in order to heal the complex hallux valgus deformity. In period 1999-2002 we used this technique on 5 patients (4 females, 1 male) with 6 surgical procedures (1 female had bilateral treatment). Indications for surgical treatment were functional problems and x-ray angle between the first and second metatarsals as well as valgus angle of the first metatarsophalangeal joint which were much higher. Pre-surgical, possibility of correction angle was exact by x-ray planing. The same examination was done after surgical treatment. After surgical care and rehabilitation program all patients had well biomechanical foot relation and they had not previous functional problems.