The validity of ESIN method of osteosynthesis compared to other active surgical methods of treatment of diaphyseal fractures of long bones in children and adolescents.

We investigated the relationship of efficiency in the application of the ESIN method of intramedullary osteosynthesis and other active surgical methods in the treatment of diaphyseal fractures of long bones in children and adolescents. The study comprised 100 subjects treated by elastic stable intramedullary osteosynthesis (ESIN - group A) and 50 subjects in whom other active surgical methods were applied (group B). The following criteria of efficiency of treatment were applied: 1. length of perioperative hospitalization, 2. time elapsed since the operation until the beginning of loading of the traumatized extremity, 3. time elapsed since the operation until the full loading of the extremity, i.e. until the recovery of the fracture, 4. incidence of complications, 5. number of post-operative outpatient clinical visits until the recovery of the fracture and 6. overall number of X-ray images of the fractured bone since the accident until the coalescence of the fracture. The results obtained in both groups were compared. 1. The length of perioperative hospitalization is shorter in patients in whom ESIN method was applied. The difference between arithmetic means was 4.45 days and is statistically significant (p < 0.001). 2. The time between the operation until the beginning of loading of the extremity is shorter in patients subjected to ESIN method of osteosynthesis, the difference of mean values being 23.49 days and is statistically significant (p < 0.001). 3. The time between the operation until the full loading of the extremity is shorter in patients subjected to ESIN method of osteosynthesis, the difference being 16.6 days and is statistically significant (p < 0.001). 4. The number of complications in patients treated by the ESIN method of osteosynthesis is not statistically different from that in group B (chi2 = 0.25, p = 0.62). 5. In postoperative period there were fewer outpatient controls in patients to whom ESIN method of osteosynthesis was applied, and the difference is statistically significant (Z = 7.69, p < 0.001). 6. Likewise, the overall number of X-ray controls was lesser (Z = 8.06, p < 0.001). The results of examining the above parameters point to a greater efficiency of treating diaphyseal fractures of long bones in children and adolescents by the ESIN method of osteosynthesis, compared to other active surgical methods.

Laparoscopic appendectomy in the treatment of acute appendicitis.

BACKGROUND: Laparoscopic appendectomy (LA) has many advantages over the classic appendectomy (CA), but this method has not been accepted yet in Bosnia and Herzegovina. Therefore, we attempted controlled randomized study in order to compare classic appendectomy with laparoscopic appendectomy and confirm eventual advantages of caring base of appendix with hem-o-lok clips regarding ordinary accepted endoloop method during laparoscopic appendectomy. METHODS: In this prospective study 120 patients were involved which are divided into two groups. In group 1, 60 patients were operated with classic method, and group II was divided into two subgroups; 30 patients were operated with laparoscopic method in which the base of appendix was cared by double endo-loop method and 30 patients were operated by plastic non-resorptive hem-o-lok clip. During this study the time duration of operation was measured, the duration of application of hem-o-lok and endo-loop, postoperative analgesia, the duration of hospitalization, intra-operative complications, anatomic position of appendix, appendicitis, and postoperative complications. RESULTS: The results of the study showed that laparoscopic appendectomy is shorter in duration if compared to the classical appendectomy with statistical significance p < 0.001 (CA 69,4 min; LAH 36,6 min; LAE 37,1 min), hospitalization is shorter p < 0.0001 (CA 3,6 days; LAH 2,3 days; LAE 2,2 days). Quantity of given analgesics in LA is less than in CA without statistical significance between LAE and CA (p > 0.340) and between LAE and LAH (p > 0.148) while there is positive statistical significance between LAH and CA (p < 0.015). Precise period of cicatrization of wound of patients operated by CA was 43 (71.66%) cases, with infection of wound in 3(5%) cases, phlegm of wound in 2 (3.3%) cases, healing of wound per sekundam in 9 (15%) cases and ileus in one (1.6%) patient. One patient had an infection of umbilical wound in LA and the other had cellulitis of front abdominal wall. Duration of application of hem-o-lok is shorter compared to endo-loop with statistical significance p < 0.013 (LAH 68,2 s; LAE 176,9 s). CONCLUSION: Time of surgery is shorter and the duration of hospitalization, amount of given analgesic is smaller, less number of postoperative complications, better cosmetic effect and advantages of application of hem-o-lok over endo-loop laparoscopic appendectomy is preferred.

War surgical care--experience from Franciscan Hospital "dr. fra Mato Nikolic" in Nova Bila during conflict in Central Bosnia (1993-1994).

This report presents experience in treatment of war injuries in Franciscan hospital "dr. fra Mato Nikolic" in Nova Bila, during the war in Central Bosnia from 1993 to 1994, in conditions of encirclement and typhoid fever outbreak. Descriptive-retrospective analysis of organization, implementation and outcomes of surgical care for patients treated from January 1, 1993 till August 20, 1994. In this period, the hospital took care of 2500 wounded persons, 2286 (91.4%) of them male and 214 (8.6%) female, their the average age being 31.5 +/- 12.8. There were 1412 gunshot injuries (56.5%), 1022 explosive injuries (40.9%), and 66 blunt injuries (2.6%). There were 1250 injuries to extremities (50.0%), 349 injuries to head and neck (14%), 233 chest injuries (9.3%) and 193 injuries to abdomen (7.7%). There were also 475 multiple injuries (19%). Surgical operations were performed in 1498 patients (60%), with surgical mortality rate of 4.5%. Total hospital mortality rate was 11.4 percent (n = 286). Despite extremely difficult conditions of work and lack of doctors, we achieved a low hospital mortality rate. The hospital continued to work after the war. Today, it is a modern health institution in Lasva Valley, Central Bosnia.