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Most of the surveyed hospitals are capable of providing essential diagnostic tests, but very few are able to do so at the point or time of presentation. While emergency medical services (EMS) have improved system-wide, emergent care interventions by EMS and within all hospitals remain limited. Further system-wide acute and emergency care improvements are forthcoming.

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The treatment of choice of mangled extremities continues to be a subject of debate among surgeons. Nowadays, much of the extremities that used to be amputated are saved, which is due to the progress in the fields of resuscitation, microvascular techniques, and advancements in fracture fixation. However, even if technical possibility of extremity salvage exists, the surgeon must always keep in mind that the final goal of the treatment is good functional outcome and to choose the modality of treatment in accordance to the principle. It is well-known that the final outcome following the treatment of the mangled extremities is influenced by plenty of factors. Until now, there are many scoring systems that are intended to guide the surgeon during the decision-making process in the acute phase of the treatment of mangled extremities. Nonetheless, many agree that the predictive value of these systems is still questionable. The process of limb salvage is lengthy, challenging and expensive, and in certain instances reoperations are necessary. Yet, morbidity and mortality are still significant. The aim of our review was to present the current knowledge regarding the mechanism of injury and initial treatment of the mangled extremity and the scoring systems available. Furthermore, we are going to discuss the controversies concerning definitive treatment and complications following these injuries.

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INTRODUCTION: An important feature of distal tibia fractures is the relevance of the soft tissue coverage. In order to maintain good functional outcome, several operative techniques have been established. Among them, percutaneous screw fixation has the advantage of causing less biological damage of the soft tissues with lower rates of complications.MATERIAL AND METHODS: We reviewed 16 patients with distal tibia fracture. Operative treatment consisted of indirect reduction and percutaneous fixation of the tibia followed by cast immobilization for approximately 3-4 months. Minimum follow up period was 12 months. Functional outcome was evaluated using Olerud-Molander Ankle Score (OMAS) and American Orthopaedic Foot and Ankle Society ankle-hindfoot score (AOFAS).RESULTS: Twelve out of 16 fractures healed within 6 months of the injury. In 3 cases, delayed union was evident, but the fractures healed in less than nine months. There was one case of malunion, two cases of superficial skin infections, two cases of DVT and two cases of gross swelling. According to OMAS score, the functional result was excellent in 7 (43.75%), good in 5 (31.25%) and fair in 4 (25%) patients.CONCLUSION: Percutaneous screw fixation can be a safe and effective method for operative treatment of distal tibia fractures.

Aim: The aim of this study is to show our experience in cases of dislocated extension typesupracondylar humeral fractures and evaluate the results of their treatment in the period from 2000 to 2010 with a follow up of a maximum six months. Material and Methods:A retrospective analysis of the clinical cases for the period 2000 -2010 was done. Children from 4 to 14 years of age with supracondylar fractures of the humerusextension type are included. The total number of patients treated at the Clinic for Pediatric Surgery was 230. Results:The results of the treatment were evaluated after the last control examination six months later. We noticed postoperative neurological damage in 10 cases (4.85%). In 14 patients (6.8%) we noticed long term deformities such as cubitus varus or cubitus valgus. Infection at the entering place of the needles occurred in 4 patients (1.94%), which did not indicate premature extraction of the needles and conversion of the treatment. Conclusion:As a conclusion, we can stress that our outcomes in treatment of dislocated suparacondylar fractures of the humerus in children meet the world standards.

Introduction: Low back pain is common medical disorder that can be caused by different etiologies, some of them being very rare. During the past decades, much of the etiology and pato-mechanics of low back pain has been clarified. However, defining precise cause of low back pain in a small subset of patients is still challenging.Case presentation: We are presenting a case of long lasting low back pain caused by impingement of the enlarged spinous process of the fifth lumbar spine into the spina bifida of the first sacral segment, so called De Anquin syndrome. We delineated the precise morphology of the anomaly using CT scans, and since the patient was symptomatic, the resection of the enlarged spinous process was undertaken. During the follow up period, the patient remained completely symptom free.Discussion and Literature review: We undertook literature review and small number of studies describing De Anquin syndrome were found. The most remarkable finding of the case presented is the immediate and complete release of pain. Conclusion:We do recommend seeking for the exact etiology in the patients with long lasting low back pain.