The challenge of osteo-articular tuberculosis in the twenty-first century: a 15-year population-based study.

SETTING: Serbia, an intermediate tuberculosis (TB) incidence country in socio-economic transition. OBJECTIVE: To examine the epidemiological and clinical pattern of osteo-articular TB (OATB) in Serbia over 15 years. DESIGN: This retrospective observational study included OATB cases diagnosed between 1 January 1993 and 31 December 2007, according to the National Referral Institute of Lung Diseases and TB in Belgrade and the Central TB Register. Population estimates with extrapolations were based on 1991 and 2002 census data. RESULTS: The 295 OATB cases represented 10.9% (range 5.3-20.2) of all extra-pulmonary TB cases notified in Serbia over the period. One tenth of these were relapses. The incidence rate showed a significant increasing trend (y = 0.1167 + 0.0175x, R(2) = 0.3196), with an average age-specific incidence rate of 0.26 per 100 000 population. The peak number of cases was in the 45-64 year age group for both men and women. The average male:female ratio was 0.85. The outcome was favourable for 279 of the 295 patients (94.6%). In addition to a standardised chemotherapy regimen, 25.4% patients underwent surgery. CONCLUSION: The increasing time trend of OATB is caused by increased morbidity, a higher TB detection rate and better notification. Although rare in children, OATB remains a challenge in clinical practice.

Burnout in Belgrade orthopaedic surgeons and general practitioners, a preliminary report.

BACKGROUND: Burnout syndrome (BOS) is caused both by psychological-emotional and physical stress. It is associated with decreased job performance and low career satisfaction. BOS has a significance influence both to physicians' performance in health care system, and in their private life. Until now, there was no data about this aspect of orthopaedic surgeon condition and health in our community. AIM: To assess the level of the burnout syndrome in orthopaedic surgeons and general practitioners (GPs), and the relations of their demographic features, job characteristics to the burnout syndrome DESIGN: Questionnaire-based survey METHODS: The sample consisted of 30 orthopaedic surgeons from the University Clinical Centre, and 40 GPs from the primary health care centres. The Burnout syndrome was measured by the Maslach Burnout Inventory (MBI). In addition to the MBI, the demographic data were collected and analyzed (age, age of practicing, gender, marital status) in relation to BOS. RESULTS: Both groups expressed moderate to high rate of emotional exhaustion, depersonalization and low personal accomplishment. However, statistical significance between the groups had not been demonstrated. Neither gender nor years of practice or marital status did express statistically significant impact on the BOS items, i.e. they were not predictors of the BOS. Our results showed that about 70% of the physicians were emotionally exhausted considering both groups. On the other hand, orthopaedics demonstrated slightly higher depersonalisation level (55%) than GPs (38%). While GPs expressed lower personal accomplishment (48%) comparing to orthopaedics (29%). DISCUSSION: The obtained MBI scores in this study were similar to those registered in US among residents, but when comparing to physicians in West Europe, which have similar health care system, our results demonstrated higher rates of BOS items. CONCLUSION: The Burnout syndrome represents an important problem for actively practicing physicians. The results of this and other similar studies should be used to evaluate medical training, practice, professional relations and introduce necessary changes.

[Comminuted intra-articular fractures of distal humerus treated with minimal fixation, one of treatment options].

Fractures of distal humerus on human skeleton are rare and intraarticular fractions of distal part of humerus occur even less freqvently, they comprise abouth 3% of fractures of humerus. However,these fractures can result in a functional deficiency of elbow joint and permanent disability. The main goal if our work was to present one of the surgical treatment options of this kind of fracture with minimal amount of fixation material. Treatment result were evaluated by Broberg-Morrey score system. Pilot study consisted of eight patient with comminuted type IV fracture of distal humerus during 2004-2005 time period. Comminuted fracture was fixed with minimal amount of material: a Kirchner needle and a screw. Patient treatment progress was evaluated initially and followed up after four, nine and twenty four months by B-M score after removal of cast and bone fixing material. The results of the B-M score after four months were: excellent in 0 patient, good in 2 patients, fair in 4 patients and poor in 2 patients. After physical therapy and follow up check- up at the end of nine months the result were: excellent in 3 patients, good in 3 patients, fair in 2 patients and no patients had shown poor result. This B-M score result was identical after 24 months follow up with minor deviations in range of motions of elbow, which did not influence the final result of B-M score.

[Nonunion--pseudoarthrosis of the scaphoid bone treated with percutaneous fixation, with compression and distraction].

Fractures, and especially pseudoarthroses of the scaphoid bone, are a great problem in orthopedic surgery, because the failure percentage is remarkably high (20-30%) even with the top modem treatment methods. Use of grafts, especially well-vascularized ones, along with good fixation, has improved treatment outcomes, but the failure and complication percentages remain high. In the pilot study, we present the first five patients with the pseudoarthrosis of the scaphoid bone, male, of 26.8 years of average age (from 22 to 34-years-old), in whom the method of extrafocal fixation, with distraction and compression, was applied. The fracture healing was achieved in all patients after an average period of 87 days (from 60 to 100 days), with the healing time also including a minimum of a month of physical therapy, after the fixator was removed. The result was evaluated using the Mayo wrist score, and from the preoperative 26 points, 82 points were achieved.

[Historical aspects of external fixation and possibilities for the future developement].

External fixation is not such a novel method, but it is interesting to learn its history, countries in which it has developed and the time when it gained full expert acceptance in treating not only fractures but orthopedic disorders, inequalities, and articular arthrodeses. The beginnings of external fixation are associated to the name of Malgaigne, followed by the authors of Western European, German and American school of external fixation. In the U.S.A., this method was accepted as late as in 1950s; being accepted in Russia through Ilizarov. In our country, the method was accepted in 1950s, through the work of Prof. Bumbaireviae and Prof. Raduloviae, who are the founders of modem external fixation in our country.

[Treatment of unstable closed tibial shaft fractures by external fixation].

The fracture of tibia shaft is one of the most common fracture of long bones. The authors bring out the results of the treatment of 90 patients with unstable closed tibial shaft fractures treated by the use of Mitkovic external fixation systems. Within the analayzed group there were 66 (73%) male and 24 (27%) female. The average patients age was 43.9 years (range 15 to 82). Excellent result in treatment of unstable closed tibial shaft fractures with external fixation were achieved in 15 (16,7%) patients, very good in 38 (42,2%) patients, good in 24 (26,7%), poor in 9 (10%) and bad in 4 (4,4%) patients. With 4 (4,4%) patients pseudoarthrosis was formed. Additional treatment of patients with pseudoarthrosis (spongioplastic and placing of CD device) led to pseudoarthrosis healing. Within the analyzed group in all patients treated with extenal fixation there were no registered cases of postoperative osteitis. External fixation by the use of Mitkovic external fixation is one of the method of choose in the treatment of unstable closed tibial fractures, providing dynamic and balanced biomehanical conditions for fracture healing.