Hip Ankylosis after Untreated Septic Arthritis by Escherichia coli : A Case Report.

Septic arthritis is usually reported in elderly patients with other underlying medical conditions. Septic arthritis by Escherichia coli is a rare infection. We are describing the case of a 70-years old patient who presented with a suppurative fistula, limited movements of the right lower limb, and a trauma that occurred at the age of 12. Throughout this time, the fistula had been present, secreting pus. A detailed clinical investigation revealed a pyogenic infection present in the femoral epiphysis followed by an elevated sedimentation rate. After the surgical intervention, E. coli was isolated from the clinical samples, and the decision to place gentamicin beads within the surgical wound was taken. The patient was treated with antibiotics. Four months after the intervention, the suppurative fistula was completely healed. Later on, the patient was no longer interested anymore in continuing with the treatment plan. As he refused to remove the gentamicin chain beads and the hip endoprosthesis, he was subsequently referred to the primary care clinic for conservative management and follow-up. He walked with a limp wearing orthopedic shoes and not using crutches or any other type of walking-aid. Four years after the surgical intervention, the gentamicin chain beads are still within the bone. Septic arthritis caused by E. coli can remain active for decades, secreting pus and self-isolating. Prompt diagnosis, adequate surgical intervention, and antimicrobial therapy are essential for the treatment.

Functional status and quality of life in post-COVID-19 patients two to three weeks after hospitalization: A cross-sectional study.

Background and Aims: Extended hospitalization due to coronavirus disease 2019 (COVID-19) is associated with residual musculoskeletal and functional deficits lasting even 6 months after discharge; therefore, it is crucial that post-hospitalized patients are promptly assessed. The aim of this study was to identify post-COVID-19 patients' functional status and quality of life, as well as to investigate their inter-relatedness 2-3 weeks after hospital discharge. Methods: The study included 39 post-COVID-19 patients previously hospitalized in the Clinic for Infectious Diseases at the University Clinical Center of Kosovo (UCCK) from August to December 2021. Physiotherapeutic assessment encompassed socio-demographic and clinical data including Short Physical Performance Battery (SPPB) for physical functional performance, hand grip strength, 6-min Walk Test (6MWT) for aerobic capacity and endurance, EuroQol 5-Dimension 5-Level (EQ-5D-5L) for quality of life, Visual Analogue Scale (VAS) for pain, Borg CR10 for dyspnea, peripheral oxygen saturation and heart rate. Descriptive statistics, Pearson correlation, and multiple linear regression analysis were utilized for data processing. Results: The median (interquartile range [IQR]) for Borg CR10, VAS pain scale, total SPPB, grip strength, and 6MWT were 1 (0-3), 3 (1-6), 9 (8-10), 30.5 (23.2-43.5) kg, 344.5 (312.7-381.7) m respectively, while the mean (SD) for EQ-5D-5L index value was 0.7 (0.2). The strongest and most significant correlation was depicted between SPPB total score and its subscales, followed by correlation with EQ-5D-5L (r = 0.719, p < 0.001), grip strength (r = 0.612 p < 0.001), Borg CR10 (r = -0.515, p = 0.001), 6MWT (r = 0.416, p = 0.02), and VAS scale (r = -0.343, p = 0.03). Using the multiple regression analysis, the grip strength, Borg-CR10, and 6MWT were found to be strongly predictive of SPPB total score. Conclusion: In post-COVID-19 patients' functional status and quality of life were impaired 2-3 weeks following hospitalization. SPPB showed the most frequent and significant correlation with other variables, hence it should be considered as one of the primary screening tools.

Splint Duration and Not the Mode of Anesthesia Is the Main Factor Influencing Avascular Necrosis After Closed Reduction for Developmental Dysplasia of the Hip in Kosovo.

The aim of this study was to determine whether the use of analgesia and sedation (AS) as opposed to general anesthesia (GA) for closed reduction and spica casting of children with severe developmental dysplasia of the hip (DDH) influenced the long-term incidence of avascular necrosis (AVN). In a prospective, randomized, single-blinded clinical trial we investigated 100 pediatric patients with DDH type IIIa, IIIb, and IV (according to Graf classification), who were randomly assigned into the group receiving AS, and the group receiving GA. Baseline demographics, splint duration, and type of DDH were carefully assessed. The presence of AVN was assessed at the follow-up visits at 1 and 7 years after the end of treatment. The AS-group consisted of 50 patients (46 girls) with 76 hips affected (n = 11/Type-IIIa, n = 32/Type-IIIb, and n = 33/Type-IV). The GA-group consisted also of 50 patients (44 girls) with 78 hips involved (n = 15/Type-IIIa, n = 34/Type-IIIb, and n = 29/Type-IV). At 7-years follow-up, AVN was diagnosed in 9 of 154 hips (5.8%), 5 hips in the AS-group and 4 hips in the GA group. The logistic regression model showed no significant difference in AVN incidence between the AS and GA groups at 7-years follow-up (p = 0.27). The multivariate regression analysis showed that neither the type of DDH nor the age at diagnosis influenced the incidence of AVN (p = 0.48 and p = 0.28, respectively). Splint duration was identified as the only significant factor for the long-term incidence of AVN in the treatment of severe DDH. For every month of longer splint duration, the odds of AVN at 7-years follow-up increased by a factor of 3.81 (95%CI: 1.35-13.73, p = 0.02). Closed reduction and spica casting of children with severe DDH under AS can be considered a feasible alternative to management under GA. All efforts must be made to diagnose patients with DDH as early as possible and shorten the duration of splint treatment to prevent the development of AVN. Level of Evidence. Level II-1.

Non-steroidal anti-inflammatory drugs and gastroprotection in primary health care users.

OBJECTIVE: The aim of this study is to assess the prevalence of gastroprotection and identify the main factors that influence the taking of protective drugs by the adult population treated with non-steroidal anti-inflammatory drugs (NSAID). METHODS: This study was cross-sectional, conducted by including a contingent of 800 users of primary health care services (n=369, 46% males and n=431, 54% females). Included in the study were individuals of both genders aged 18+ who sought counselling or treatment during the three-month period. The data collection of this study was based on the completion of a structured questionnaire, which included questions related to the use of NSAIDs, the way these drugs were prescribed and administered and the simultaneous taking of gastroprotective drugs. RESULTS: The prevalence of the gastroprotective drugs use was higher among the elderly, individuals living in urban areas, those with higher education, those with daily use of NSAID, individuals receiving prescriptions from their own doctors, and those suffering from side effects from the use of NSAID, as well as subjects that had a longer duration of NSAID use. Diclofenac was the most prescribed NSAID. Gastric pain and dizziness were the most experienced side effects. CONCLUSION: This paper demonstrates the need to improve the quality of primary health care service through informing and educating patients regarding the need to take gastro-protective drugs for those at high risk of adverse effects manifested by the use of NSAIDs.

[Subacute Acetabular Osteomyelitis Caused by Proteus Mirabilis. A Case Study].

Subacute acetabular osteomyelitis is a rare disease of bone. Deep location of the infection site sometimes may delay diagnosis. The most common cause is Staphylococcus aureus, whereas Proteus organisms are very rare etiologic agents. The aim of this case report is to present an unusual case of subacute acetabular osteomyelitis caused by Proteus mirabilis in a 12-year-old boy. Subacute acetabular osteomyelitis can be induced by Proteus mirabilis in the absence of previous trauma, predisposing conditions or disease. The patient was successfully treated with antibiotics. Local biopsy was essential in diagnosing this infection. Antibiotics should be given only after clinical sampling and susceptibility tests.

Exercise and Therapeutic Ultrasound Compared with Corticosteroid Injection for Chronic Lateral Epicondylitis: A Randomized Controlled Trial.

BACKGROUND: Lateral epicondylitis, or tennis elbow, is a common overuse syndrome of the extensor tendons of the forearm. When the condition is chronic or not responding to initial treatment, physical therapy is initiated. The objective of this study is to compare the effectiveness of corticosteroid injections with physiotherapeutic interventions (ultrasound and exercise) for the treatment of chronic lateral epicondylitis. MATERIAL AND METHODS: We performed a randomized controlled trial of 12 weeks' duration in patients with chronic lateral epicondylitis. We randomly assigned 49 subjects to an exercise group (n=25), who received ultrasound and exercise, and a control group (n=24), who were treated with local infiltration of 1mL triamcinolone acetonide (10mg/mL) and 1mL lidocaine 2%. To evaluate the subjects, three instruments were used: pain intensity, measured with a Visual Analogue Scale (VAS), functional disability, measured with the Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire, and painfree grip strength. All subjects were evaluated before treatment and at the 6th and 12th week. RESULTS: There were no significant differences between the two groups with regard to any variable at baseline (p>0.05). In the exercise group, significant improvements were demonstrated for VAS, PRTEE pain score, PRTEE function score and pain free grip strength, compared to the control group. The exercise group reported a significantly greater increase in all variables at 12 weeks than did the control group (p<0.001). CONCLUSION: Our results suggest that ultrasound therapy and exercise are beneficial in the treatment of tennis elbow.

Surveillance of antibiotic and analgesic use in the Oral Surgery Department of the University Dentistry Clinical Center of Kosovo.

BACKGROUND: Because Kosovo has no reliable information on antimicrobial and analgesic use in dental practice, the survey reported here evaluated the antibiotic and analgesic prescriptions in the Oral Surgery Department of the University Dentistry Clinical Center of Kosovo (UDCCK). METHODS: The data of 2,442 registered patients for a 1-year period were screened and analyzed concerning antibiotic and analgesic use as per standards of rational prescription. RESULTS: Dentistry doctors prescribed antibiotics significantly more often than analgesics. Antibiotics were prescribed in 8.11% of all cases, while only 1.35% of total prescriptions were for analgesics. The total consumption of antibiotic drugs in the UDCCK was 4.53 Defined Daily Doses [DDD]/1,000 inhabitants/day, compared with only 0.216 DDD/1,000 inhabitants/day for analgesics. From a total number of 117 patients, 32 patients received combinations of two antibiotics. CONCLUSION: Pharmacotherapy analysis showed that the prescription rates of antibiotics and analgesics in the UDCCK are not rational in terms of the qualitative aspects of treatment. For the qualitative improvement of prescription of these drug groups, we recommend the implementation of treatment guidelines following rational standards.

Kosovo's Public Health Damage from Abusive Use of Antibiotics in Dairy Cattle.

INTRODUCTION: The aim of the study is to assess the state of the use of antibiotics in dairy cattle in Kosovo according to different diagnosis as directed by treatment protocol and to evaluate the methods of their application in dairy cattle. METHODS: We've visited over 80% of dairy farms throughout the territory of Kosovo in 2013. Assessment was carried out through a specific questionnaire, which identifies problems with medical treatment of cattle, the number of cattle treated and untreated, description of dose and type of drugs used, as well as the duration of drugs issuance. RESULTS: In Kosovo for the treatment of sick cows are mainly used beta lactams and sulfonamides. The drugs were not given only to sick cattle by their diagnosis, but they were given to healthy cattle too, as a preventative therapy, mainly through intramuscular route. CONCLUSION: We conclude that the dairy cattle were not treated correctly as directed by the treatment protocol. In Kosovo's general health system there are no rules and procedures on monitoring and recording the expenditures on antibiotics.

Low back pain and obesity.

INTRODUCTION: Low back pain poses a significant problem in clinics and public health. It presents one of the main problems with adults, since 70-80% of adults experience it at least once in their lifetime. Causes of the low back pain are numerous and often unknown. OBJECTIVES: The aim of the study is to find the most prevalent age group, pain localisation, and the frequency of physical therapy sessions in obese and non-obese subjects with LBP. MATERIALS AND METHODS: The study has been conducted by the Physical Rehabilitation Service of the Occupational Medicine Institute, during one year period. The total number of patients studied was 101 and all were Kosovo Energy Corporation (KEC) employees. The study was retrospective. RESULTS: Looking at the body weight index, out of 101 patients, 69.3% are classified as non-obese and 30.7% as obese. Using T-Test we have found a difference of high statistical significance between the average number of the physical therapy sessions applied in relation to the examined groups (T-Test=2.78, P=0.0065, so, P<0.01). CONCLUSION: Obesity and age have no direct influence in back pain, but they could prolong healing. Professional occupation and binding position are factors that affect back pain. Physical workload can cause the manifestation of sciatica; whereas psycho-social factors can prolong the overall healing process.

Physiological cost index and comfort walking speed in two level lower limb amputees having no vascular disease.

BACKGROUND: The Physiological Cost Index (PCI) was introduced by MacGregor to estimate the energy cost in walking of healthy people, also it has been reported for persons with lower limb amputation, walking with prosthesis. OBJECTIVE: To assess energy cost and walking speed in two level lower limb amputation: transfemoral and transtibial amputation and to determine if the age and prosthetic walking supported with walking aids have impact on energy cost and walking speed. METHODS: A prospective cross sectional study was performed in two level lower limb amputees with no vascular disease who were rehabilitated at the Department of Prosthetics and Orthotics at the University Clinical Center of Kosovo. The Physiological Cost Index (PCI) was assessed by five minutes of continuous indoor walking at Comfort Walking Speed (CWS). RESULTS: Eighty three lower limb amputees were recruited. It is shown relevant impact of level of amputation in PCI (t=6.8, p<0.001) and CWS (T=487, p<0.001). The great influence of using crutches during prosthetic walking in PCI (ANOVA F= 39.5 P < 0.001) and CWS (ANOVA F=32.01, P <0.001) has been shown by One Way ANOVA test. The correlation coefficient (R) showed a significant correlation of age with PCI and CWS in both groups of amputation. CONCLUSIONS: Walking with transfemoral prosthesis or using walking aids during prosthetic ambulation is matched with higher cost of energy and slower walking speed. Advanced age was shown with high impact on PCI and CWS in both groups of amputees.

OUTCOME OF PHYSICAL THERAPY AND SPLINTING IN HAND BURNS INJURY. OUR LAST FOUR YEARS' EXPERIENCE.

OBJECTIVE: Burn injuries in hands are much more complex and the appearance of contractures is a common complication. Hand burn injuries often result in limited functionality, flexion and extension of fingers and present a major hindrance in rehabilitation. The aim of physical therapy and splinting after hand burn injury is to maintain mobility, prevent the development of the contracture and to promote the functionality of hand and good cosmetic results. The purpose of this study is to presents our experience of 38 children with hand burn injuries, admitted and treated at the Department of Plastic Surgery, UCCK-Pristina, Kosovo, during the years 2012-2015. METHODS: Physical therapy is focused on active/passive range of motion in affected joints, management of cicatrix, strengthening exercise, coordination and use of splints for correction contractures. Patients were evaluated in three, six months and the definitive evaluation is done after 9 months of physical therapy and splinting. RESULTS: We have improvement in range of motion (ROM), functionality, coordination, muscle force, decrease of keloids scars. CONCLUSION: This study shows the importance of physical therapy and splinting, achieving good results in preventing contracture, improving range of motion, muscle force and good cosmetic results.

IMPACT OF MORNING STIFFNESS, EDUCATION, AND AGE ON THE FUNCTIONAL STATUS OF PATIENTS WITH RHEUMATOID ARTHRITIS.

The purpose of this study was to explore the relationship between disability status and duration of morning stiffness in hands with regard to age, level of education, and gender in patients with rheumatoid arthritis (RA). Also, the authors wanted to investigate this relationship with regard to the presence of rheumatoid factor, i.e., the serological status. A retrospective study was conducted in 250 patients with the classic form of RA (186 females, s64 males, mean age Xb = 49.96 y ears, range 25-60 years, disease duration 1-27 years, Xb = 6.41) previously diagnosed with RA according to the ACR (American College of Rheumatology 1987 criteria). All patients were in Steinbrocker functional classes II and III. The probability level was expressed by p < 0.01 and p < 0.05. The relationship between the variables was measured by point-biserial correlation. The correlation between duration of morning stiffness and functional class was positive but low [(r = 0.10, y = 0.00x + 2.37, p > 0.05) seronegative, (r = 0.12, y = 0.00x + 2.30, p > 0.05) seropositive]. High positive values were obtained for the linear correlation coefficient between duration of the disease and functional class (p < 0.01). Also, high values were obtained regarding the coefficient of correlation between age and functional class [(r = 0.29, p < 0.01) seronegative, (r = 0.47, p < 0.01) seropositive]. Uneducated patients were significantly more represented in functional class III [ 23 (50%) seronegative, 19 (42.2%) seropositive] than in functional class II [16 (20.3%) seronegative, 22 (27.5%) seropositive]. In conclusion, in this study of patients with rheumatoid arthritis, increased duration of morning stiffness was associated with functional disability. Functional disability increased with the duration of the disease, depended on age and educational level, and was more pronounced in older age, regardless of RA serological status. With regard to serological status and sex, the differences were non-significant.

Risk Factors for Injuries in Professional Football Players.

AIM: The aim of this study was to identify risk factors related to the occurrence of injuries in football players. MATERIALS AND METHODS: The study included 216 football players from 12 teams in the elite football league. Football-related injury data were collected prospectively during the 2012/2013 competitive season. At baseline the following information was collected for the players: anthropometric measurements (weight, height, BMI, subcutaneous skinfolds), playing experience, injury history, physical fitness performance test (agility run), peak oxygen uptake. The incidence, type and severity of injuries and training and game exposure times were prospectively documented for each player. RESULTS: Most of the players (n = 155, 71.7%) sustained the injures during the study period. The overall injury incidence during the regular season was 6.3 injuries per 1000 athlete-exposures (95% confidence interval, 4.31-9.67). Multivariate logistic regression analysis showed that playing experience (odds ratio [OR] = 0.44; 95% CI = 0.32-0.61, p < 0.01), age (OR = 2.05; 95% CI = 1.49-2.81, p < 0.01) and a previous injury (OR = 4.4; 95% CI = 2.14-9.07, p < 0.01) were significantly correlated to increased risk of injuries. Body mass index was not associated with risk of injury. Strains (34.19%) and sprains (25.81%) were the major injury types. Twenty-seven percent of injured players were absent from football for more than 1 month, with knee injuries (25.42%) being the most severe type. CONCLUSION: The risk factors that increase injury rates in football players were previous injury, higher age and years of playing. Future research should include adequate rehabilitation program to reduce the risk of injuries.

A comparison of mckenzie therapy with electrophysical agents for the treatment of work related low back pain: A randomized controlled trial.

BACKGROUND AND OBJECTIVE: Chronic low back pain (LBP) is a major public health problem in industrialized countries and is one of the most common reasons for seeking healthcare. Although the McKenzie therapy is widely used for the treatment of low back pain, there is evidence for no improvement with exercise in short-, intermediate-, or long-term outcomes of pain relief or function. The aim of this study was to compare the effect of the McKenzie therapy with electrophysical agents (EPAs) in patients with chronic LBP. MATERIAL AND METHOD: A randomized controlled comparative trial with a 3-month follow-up period was conducted between January 2009 and June 2012. 271 patients with chronic LBP, (more than three months duration of symptoms) were randomized into two groups: the McKenzie therapy group (n=134), and electrophysical agents group, (n=137). The treatment period of both groups was 4 weeks at an outpatient clinic. Clinical outcomes (pain intensity, trunk flexion range of motion, and disability) were obtained at follow-up appointments at the end of the treatment period, 2 and 3 months. RESULTS: Significant improvement of spinal motion, reduction of pain and disability were demonstrated in both groups but the results show the greater improvement in the McKenzie group (p< 0.05). CONCLUSION: McKenzie therapy reduces pain, and disability, among subjects with chronic LBP. This study revealed that the McKenzie therapy is more effective than EPAs group.

Energy expenditure and walking speed in lower limb amputees: a cross sectional study.

BACKGROUND: Energy expenditure and walking speed are generally recommended for use as measures of status and outcome for walking. The objective of this study was to measure the physiological cost index (PCI) and comfort walking speed (CWS) at three levels of lower limb amputation: transfemoral, transtibial and Syme level, and the relationship of these physiological variables to prosthetic ambulation supported with walking aids and stump length. MATERIAL AND METHODS: This study was a prospective cross-sectional study.Eighty-nine individuals with lower limb amputation for reasons other than peripheral vascular disease (PVD) were recruited among patients at the Department of Prosthetics and Orthotics in University Clinical Center of Kosovo. PCI was assessed by five minutes of continuous indoor walking at CWS. RESULTS: Significant differences were found in PCI (F=29.87, P < 0.001) and CWS (F=19.33, P < 0.001) among the three amputation groups. Prosthetic ambulation supported with crutches showed an important impact on PCI (F=35.1, P < 0.001) and CWS (F=28.42, P < 0.001). Stump length was associated with significantly increased PCI (r=0.53, P = 0.02) and reduced CWS (r=0.58, P = 0.004) in transfemoral amputees. CONCLUSIONS: 1. A higher level of amputation is associated with less energy-efficient walking and with lower walking speed. 2. Prosthetic ambulation supported with crutches has significant impact on increasing of energy expenditure and decreasing walking speed. 3. Stump length is shown to have a major impact on PCI and CWS in transfemoral amputees.

The effect of aerobic exercise on quality of life among breast cancer survivors: a randomized controlled trial.

OBJECTIVE: To determine the effect of moderate-intensity aerobic exercise on the quality of life (QOL) and physical functioning in breast cancer survivors. MATERIALS AND METHODS: We randomly assigned 62 breast cancer survivors to an exercise (N = 30) or control group (N = 32). The exercise group trained at a moderate intensity progressing from 25 to 40 min over a 10-week period. The control group did not train. Outcomes were assessed at baseline and postintervention. The primary outcomes were overall QOL--as assessed by the functional assessment of cancer therapy-breast (FACT-B) scale. Secondary outcomes were changes in various subscales of overall QOL, and changes in body composition outcomes: body weight, body mass index, and changes in performance in a 12 min walk test (12MWT). RESULTS: Sixty-two of 73 women randomized (84.9%) completed the study. There were no significant differences amongst the two groups at baseline for any variable. In the exercise group significant improvements were demonstrated for the FACT-B (13.4 points, P < 0.003), functional assessment of cancer therapy-general (FACT-G) (9.16 points, P < 0.008), the functional well-being subscale (P < 0.010), and the emotional well-being subscale (P < 0.035) compared to the control group. No significant changes in body weight or BMI were observed. Exercise group showed a significant increase in 12MWT (P < 0.009). CONCLUSION: We conclude that 10 week of moderate-intensity aerobic exercise program significantly improves QOL and physical functioning in breast cancer survivors. Future studies are needed to evaluate the effectiveness of similar exercise programs over longer periods of time and involving a greater number of breast cancer survivors.

The effect of land versus aquatic exercise program on bone mineral density and physical function in postmenopausal women with osteoporosis: a randomized controlled trial.

BACKGROUND: Osteoporosis is a multifactorial progressive skeletal disorder characterized by reduced bone mass. Exercise is widely recommended to reduce osteoporosis, falls and related fragility fractures. The purpose of this study was to investigate the effects of land exercise (LE) and aquatic exercise (AE) on physical function and bone mineral density (BMD). MATERIAL AND METHODS: Fifty-eight postmenopausal women, aged 50-70 years, diagnosed with osteoporosis according to BMD measures, enrolled in this study. The subjects were randomly assigned to either the intervention group (LE group) or the control group (AE group). Physical function and BMD were assessed in all subjects in both groups before and after 10 months of intervention. Muscle strength, flexibility, balance, gait time and pain were measured to assess physical function. Bone mineral density at the lumbar spine was measured by dual energy X-ray absorptiometry (DEXA). RESULTS: There were no significant differences between the two groups in the baseline anthropometric data. The two groups were similar with respect to age, weight, height, and body mass index (p>0.05). After the exercise program, muscle strength, flexibility, gait time, pain, and bone density (p<0.001) improved significantly with LE compared to AE. There was no significant difference between the two groups with regard to balance at the 10-month follow-up. CONCLUSION: Significant improvements in physical function and BMD suggest that LE is a possible alternative for postmenopausal women with OP.

Physical therapy and splinting after flexor tendon repair in zone II.

INTRODUCTION: Early physical therapy and splinting after flexor tendon repair in zone II is very important to improve tendon healing, increase tensile strength, decrease adhesion formation, early return of function and less stiffness and deformity. We conducted a study to observe and record the results of early active mobilization of repaired flexor tendons in zone II. MATERIALS AND METHOD: This study reports the results of physical therapy and splinting which was applied to 75 patients with 76 digits after flexor tendon repair in zone II, treated at the Department of Plastic Surgery and Physical and Rehabilitation Medicine Clinic, Pristine-Kosovo. Physical therapy and splinting started the first day after surgery and have lasts until week 12. Patients were evaluated with regarding to the range of motion and grip strength. The assessments were done at the 8, 10, 12 weeks and the finale assessments were done after 6 months. RESULTS: Range of motion after 6 months according to the Strickland Classification were excellent in 21.1%, good in 44.7, fair in 11.8% and poor in 22.4%. Grip strength was good in 63.8% of cases. CONCLUSION: Results of this study shows that using a physical therapy and splinting achieve good results in range of motion, muscle force and early return of function of the hand.

Rehabilitation outcome following war-related transtibial amputation in Kosovo.

BACKGROUND: Previous literature has suggested that age, level of amputation, residual limb length, comorbidities, mental disorders, and cause of amputation can affect the ability to successfully ambulate with prosthesis. OBJECTIVES: The objective of this study was to analyze the predictors that affect the rehabilitation outcome of war-related transtibial amputees and the relationship of these factors with ambulation ability after prosthetic fitting. STUDY DESIGN: Retrospective observational study. METHODS: We reviewed the records of 69 war-related transtibial amputees. The rehabilitation outcome was analyzed according to the grade of rehabilitation summarized in three grades. Multiple logistic regression analysis was used to determine the odds of achieving the first rehabilitation grade. RESULTS: The majority of patients with transtibial amputations achieved the first grade of rehabilitation (59.4%). The factors that significantly influenced the achievement of the first grade of rehabilitation were age and absence of posttraumatic stress disorder. For every 1-year increase in patient age, the odds of achieving first grade of rehabilitation decreased by a factor of 0.9. Patients without posttraumatic stress disorder had 12.9 greater odds of achieving the first rehabilitation grade compared to patients with posttraumatic stress disorder. CONCLUSION: Achievement of the first grade of rehabilitation among war-related transtibial amputees is dependent on patient age and the absence of posttraumatic stress disorder. CLINICAL RELEVANCE: Understanding the factors that may affect the rehabilitation outcome of war-related amputees could lead to a more specific organization of the rehabilitation, especially in a country that has recently been involved in war. This is the first study to focus on determinants of prosthetic rehabilitation in these patients.

Rehabilitation after surgery repair of flexor tendon injuries of the hand with Kleinert early passive mobilization protocol.

INTRODUCTION: Rehabilitation after surgery repair of flexor tendon injuries of the hand remains challenging and requires experienced professionals and interdisciplinary approaches. AIM: The aim of this study was to evaluate rehabilitation results after surgery repair of flexor tendon injuries in the hand with the early passive mobilization--Kleinert protocol. MATERIALS AND METHODS: In this retrospective case-series study rehabilitation results of flexor tendon injuries in the hand with the early passive mobilization--Kleinert protocol were evaluated in 35 patients, treated in the Orthopaedic Clinic University Clinical Centre of Kosovo between December 2007 and November 2008. Patients had unilateral injuries on right hand without associated injuries. Patients were divided in three groups: patient with injury of FPL (n = 15), patient with injury of FDP and FDS dig. I-V (n = 10) and patient with injury of FDP and FDS dig.II (n = 10). Patients were included in a rehabilitation program using the Kleinert-early passive mobilization protocol. Functional evaluation was made using the mean improvement on MCP, PIP and DIP joints motion, mean functional are of motion (FAM) and total active motion (TAM) scoring system of The American Society of Surgery of Hand. The functional outcomes were analyzed by Paired t-test, and One way Analysis of Variance, while the mean TAM score were compared using the Wilcoxon Matched-Pairs Signed-Ranks test with significance set at p < 0.05. RESULTS: About 67% of patients with FPL injuries achieved excellent range TAM score, and about 22% of patients with FDS&FDP injuries achieved excellent and 74% good range of total active motion. CONCLUSIONS: With earlier performed primary surgical tendon repair followed by Kleinert-early passive mobilization protocol may achieves satisfactory functional results for any flexor tendon injuries in zones I-IV of the hand.