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In the clinical part of the study results of trochanteric fractures surgical treatment were analysed in 67 patients treated at the Clinic for Orthopedics and Traumatology of Clinical center Niš, using two different methods of internal fixation: intramedullary gamma nail fixation (Gamma Nail - GN) and extramedullary fixation with Self-dynamisable Internal Fixator with 2 sliding screws (Self-dynamisable Internal Fixator - SIF). Comparison of these two methods was performed in terms of the following clinical parameters: operative time, intraoperative fluoroscopy time, intraoperative and postoperative infusion and transfusion, time of hospitalization, hip function and health-related quality of life at least 2 years after surgery. There were significantly higher values of operative time, intraoperative fluoroscopy time and amount of intraoperative infusion in the GN group compared to the SIF group, suggesting appropriate differences in the number of daily operations planned, in requirement of operating room staff protection from intraoperative x-ray and in planning the required intraoperative infusion. There was no significant difference between SIF group and GN group regarding the other clinical parameters mentioned. There can be concluded that application of GN and application of SIF with 2 sliding screws require the same amount of transfusion and same time of hospital stay, as well as providing the same final clinical result in the treatment of trochanteric fractures. In the laboratory part of the study, the axial forces required to initiate the dynamization of the sliding screws, during the transversal load of these screws, was measured and analysed for GN, SIF with 2 sliding screws and SIF with cannulated sliding screw. Regression parameters of the dependence between the forces required to initiate sliding screws dynamization and the bending moments of their transverse load were calculated afterwards. Increasing of force required to initiate dynamisation by increase of the bending moment was found to be highest for SIF with 2 sliding screws, then for gamma wedges, and the lowest was for SIF with a cannulated sliding screw. Regarding laboratory results, there can be concluded that, in the moment of weight bearing on the operated leg, the initiation of sliding screw dynamisation will not be realized in patients with higher values of body weight or femoral neck length. Thus, it is recommended to perform frequent movements in the operated hip without full weight bearing at the first postoperative rehabilitation time in these patients.

Introduction: The incidence of fracture of the femur bone ranges from 1.5 to 9.9: 100 000 persons during the year, and most commonly isolated injuries. Material and methods: The study was conducted on a sample of 100 subjects with 104 fractures, divided into two groups based on the treatment method. The average monitoring time is 12-23 months. In the first group, with selfdynamizable internal fixator (SIF) was used in 55 patients with 57 fractures. In the second group, in 45 subjects with 47 fractures treated with interlocking femoral nails. Both surgical methods are based on the concept of relative stability. For AO / ASIF classification (type A 39, tips B 51, type C 14), Winquist Hansen (type I 28, type II 39, type III 23, type IV 14) and Gustillo Anderson classification (Type I 7 and Type II 2). The analized complications are: infection, nonunion, deformity of the extremities (malposition of the axis, rotation and length), malunion et break and displacement of osteosynthetic material, deep vein thrombosis, pulmonary embolism, neurovascular injury, compartment syndrome, and amputation. Objective: Comparative analysis of the process of scaling, functional recovery and complications between these two methods of treatment of femoral shaft fracture. Discussion: Protocols and trauma scores provide guidelines for a diagnostic pathway for adequate orthopedic care, contributing to reducing morbidity, mortality and more successful treatment. In politraumatized special effects in improving treatment, it has been shown through guidelines based on two principles: early total care ETC and damage control orthopaedic DCO. Conclusion: Both methods equally enable the achievement of good results of treatment, which is displayed through the values of the analyzed parameters.

Introduction: Femoroacetabularni impingement is the pathophysiological mechanism of early contact of the femoral head and neck junction with the anterior or antero-superior edge of the acetabulum, in patients with the small morphological bone changes in the hip. Objective: To prove that there are at least two main morphotypes changes in the proximal femur: one, with femoral head tilt posterior and/or inferior, relative to the femoral neck in patients with cam form of the femoroacetabular impingement and the other morphotype, without femoral head tilt in relation at the femoral neck or, if the tilt exists, then it was significantly lower in patients with mixed form of femoroacetabular impingement. To show, that surgical correction of soft tissue and bone changes in the form of a bone bank at the femoral head and neck junction in patients with cam and mixed form femoroacetabular impingement, leads to a significant improvement of subjective complaints of patients, objekiv clinical findings and to the stabilization of radiographic parameters in relation to preoperative findings. Method: The study included three groups of respondents, 78 pilot group persons, 28 mixed form femoroacetabular impingement operated persons and 31 cam form femoroacetabular impingement operated persons. All subjects were aged 18-55 years, approximately equal gender representation. In pilot group pearsons, only anteroposterior and profile radiographs of the hips were done, and in operated person, clinical and operative method was used in addition to radiographic images, and all tested parameters were statistically analyzed. On the hips radiograms, parameters available in the literature and the parameters identified for the first time were measured and tested for the purpose of this dissertation. Results: Results of the dissertation were grouped on demographic, clinical and radiographic results with special emphasising of the normal radiographic values in patients of the pilot group and pathological values of clinical and radiographic preoperative and postoperative results of the operated patients of mixed and cam form of femoroacetabular impingement. For the pilot group pearsons parameter values, that exist in the literature were, standardized and compared with the same values of the newly introduced parameters that are not present yet in the literature, and in other operated person, the values of all parameters were tested before and after surgery, and than compared with the values of those of the pilot group pearsons and with the values that exist in the literature. Newly introduced parameters by using contingency tables were tested for sensitivity, specificity, positive and negative predictive values of parameters. There were significant differences between preoperative and postoperative values of the tested parameters in both operated groups and using the newly introduced parameters four morphotypes of the femoral head tilt relative to the neck were identified. Conclusion: We have identified two morphotypes of the secondary bone changes at the femoral head and neck junction that are significantly different between the pearsos operated from mixed and cam form of the femoroacetabular impingement. Four types of primary pathological changes in the form of the femoral head tilt were found with a significant difference in the degree of inclination of the slope and in the distribution of the femoral head tilt in both operated group of persons. There were a significant differences in the preoperative and postoperative values of parameters within each group of the operated persons, and a significant difference in the values of the tested parameters between the groups, but overall, there was a significant improvement of subjective, clinical and radiographic parameters after surgical treatment of the both operated groups of pearsons.

Introduction: Gonarthrosis in a certain number of cases requires surgical treatment – knee arthroplasty. Bilateral gonarthrosis is a common finding. Patients with bilateral gonarthrosis can be operated in one procedure, during one course of a hospital stay, which may have significant advantages over delayed procedure. Bilateral knee arthroplasty in one procedure is routinely performed in some orthopedic centers, and in other, due to potentially higher risks of this approach, patients are operated in two surgical procedures with various time intervals between two arthroplasties. The aim of the study is to determine the advantages and risks of bilateral knee arthroplasty in one procedure in relation to bilateral total knee arthroplasty in two procedures. The aim was to determine the benefits and risks of bilateral knee arthroplasty in one act in relation to bilateral total knee arthroplasty in two acts. Methods: Retrospective study, in the first group, 256 patients of both gender, who had bilateral total knee arthroplasty in one act in the Department of Orthopaedic Surgery and Traumatology, Military Medical Academy in Belgrade from 01. january 2004. to 31. december 2011. year, in the second group were 165 patients who had bilateral total knee arthroplasty in two acts in the same department and in the same period. In all cases, an identical surgical approach and technique was used, with the standard antibiotic prophylaxis and thromboprophylaxis with low-molecular weight heparins. We assessed the risk of postoperative mortality, complications, functional outcome, the need for transfusions, and length of hospital stay. Results: This analysis shows that in the examined groups of patients, SBTKA and BTKA in two acts, who had no significant differences in the presence of preoperative comorbidity and age, there were no statistically significant differences in postoperative 30-day mortality, postoperative complications, infections and revision surgery. When it comes to the assessment of the functional outcome and length of hospital stay SBTKA shows significantly better results compared to BTKA in two acts. 7 Conclusion: Results of this study show that SBTKA even in patients with recorded preoperative comorbidities can be safe and successful procedure with acceptable low incidence of postoperative complications.

Hip fractures represent a major challenge for today's healthcare systems, especially in countries with burgeoning elderly population, mostly due to mortality and morbidity, and often lengthy hospitalization followed by a number of complications. Patients after hip fracture have a significantly higher mortality after the fracture than patients of the same age without fractures. Numerous studies have linked an increase in mortality and the incidence of complications with delay of surgical treatment. Operative treatment of hip fractures is the treatment of choice, but there are no clearly defined time frames for undertaking of operative treatment. The aim of the study was to determine the influence of timing of surgery for hip fracture outcomes and complications. Based on the findings of the study, early operative treatment of hip fractures, if adequate preparation and selection of patients is conducted, is a safe and in regard to some clinical parameters superior option, compared to delayed surgical treatment. The findings of this study, although give preference to early surgical treatment, do not simplify the choice between early or delayed operative treatment. The question of whether to operate as soon as medical conditions allow, or to delay in accordance with comorbidities or institutional reasons will persist in everyday orthopaedic work. The choice will, in most cases, continue to be the result of a complex compromise between the patient's health status, institutional conditions and the attitude of the attending orthopedic surgeon.

This doctoral thesis deals with the current problem of osteoarticular system and trochanteric fracture treatment of people who are 60 or more years old. The fracture is treated by extramedular implants, DHS-YU, selfdynamizing fixator-Mitkovic and DHS-Richards. The thesis contains both experimental and clinical part of study. In the experimental part of the thesis, you can find a research carried out on biomechanic characteristics of the implants and dinamization at the axis neck under cyclic loading. Wooden femur models with virtual trochanteric fracture are used (under fracture corner of 45º) and they are fixed with a corresponding implant. At the Faculty of Engineering in Nis, a research was carried out with a specific instrument used for cyclic examination. It has been used for the implant testing since 2007. Wooden femur models are used for testing the implant resistence on the axial force. As an equipment part, we used a “twitcher” (Veb Thuringer Raunsteim). During the procedure we used power of 1000N. One hundred and fifty patients who were 60 or more years old, took part in the clinical prospective study.They all had a trochanteric fracture and were all treated with the dynamic extramedular implant, DHS-YU, self-dynamizing fixator-Mitkovic and DHS-Richards, at the orthopedic ward in Cuprija and at the orthopedic clinical ward in the Health Center in Nis. The research period lasted from January 1st 1995 to June 1st 2010. The following parameters were recorded: the patients’ sex and age, fracture type and operation duration, blood compensation, application of antibiotics, pain, range of movement, muscle power, verticalization time, curtailment of the limb operated on, patients’ walk and activity after operation. Mechanic complications, superficial and deep infections, duration of hospitalization, mortality and final functional results were also recorded. The final treatment results were estimeted with Salvati-Wilson scale modified by Todorovic and Jevtic. The author has come to conclusions which are reliable and applicable. Momčilo Todorović – Doktorska disertacija Komparativna analiza rezultata lečenja trohanternih preloma - 187 - During the test of dynamization of the neck axis with cyclic loading applied on the femur model, the dynamization happens in an early phase in the case of all the three implants. During the testing process of the continual axial force at 1000N, none of the implants’ plastic is deformed. Apart from dynamization in the neck axis, existing in all the three extramedular implants, dynamization along the axis of the femur, existing in the selfdynamizing inner fixator-Mitkovic, has an advantage when we compare it with the other extramedular implants. According to the clinical research results, in the treatment of femur trochanteric fracture with dynamic extramedular implants (DHS-YU, selfdynamizing inner fixator Mitkovic, DHS-Richards) we can say that all the implants are anatomically and functionally very efficient. The treatment of trochanteric fractures treated with DHS-YU implants compared with the treatment of trochanteric fractures treated with DHS-Richards implants, shows that better results are achieved with DHS-implants if we consider patients’ supporter,walk and activity after operation. It has been confirmed that there is no great statistic difference in the analyzed parameters between patients who are treated with DHS YU extramedular implant and patients treated with selfdynamizing inner fixator – Mitkovic. The study results are very important for trochanteric fracture treatment applied on older patients.