PurposeTo investigate whether the surgical technique of single-bundle anterior cruciate ligament (ACL) reconstruction, the visualization of anatomic surgical factors and the presence or absence of concomitant injuries at primary ACL reconstruction are able to predict patient-reported success and failure. The hypothesis of this study was that anatomic single-bundle surgical procedures would be predictive of patient-reported success.MethodsThis cohort study was based on data from the Swedish National Knee Ligament Register during the period of 1 January 2005 through 31 December 2014. Patients who underwent primary single-bundle ACL reconstruction with hamstring tendons were included. Details on surgical technique were collected using an online questionnaire comprising essential anatomic anterior cruciate ligament reconstruction scoring checklist items, defined as the utilization of accessory medial portal drilling, anatomic tunnel placement, the visualization of insertion sites and pertinent landmarks. A univariate logistic regression model adjusted for age and gender was used to determine predictors of patient-reported success and failure, i.e. 20th and 80th percentile, respectively, in the Knee injury and Osteoarthritis Outcome Score (KOOS), 2 years after ACL reconstruction.ResultsIn the 6889 included patients, the surgical technique used for single-bundle ACL reconstruction did not predict the predefined patient-reported success or patient-reported failure in the KOOS4. Patient-reported success was predicted by the absence of concomitant injury to the meniscus (OR = 0.81 [95% CI, 0.72–0.92], p = 0.001) and articular cartilage (OR = 0.70 [95% CI, 0.61–0.81], p < 0.001). Patient-reported failure was predicted by the presence of a concomitant injury to the articular cartilage (OR = 1.27 [95% CI, 1.11–1.44], p < 0.001).ConclusionSurgical techniques used in primary single-bundle ACL reconstruction did not predict the KOOS 2 years after the reconstruction. However, the absence of concomitant injuries at index surgery predicted patient-reported success in the KOOS. The results provide further evidence that concomitant injuries at ACL reconstruction affect subjective knee function and a detailed knowledge of the treatment of these concomitant injuries is needed.Level of evidenceRetrospective cohort study, Level III.

Background: According to the UNHCR, 250 million people currently live outside their country of birth. The growing multicultural population poses a major challenge to healthcare professionals who aim to provide individualized, holistic care, which respects the individual’s autonomy. To ensure basic rights, healthcare interventions should be guided by the value of benefiting others; individuals should be treated honestly, equally, and impartially. Objective: To investigate immigrant doctors’ experiences of using interpreters in the Swedish health-care system. Material and Methods: Twenty-eight doctors, 12 men and 16 women from Bosnia and Herzegovina, Croatia, Macedonia and Serbia participated in four focus group interviews (FGI). The interviews were audio recorded, transcribed and analyzed using content analysis method. Results: The best results in the present study were achieved in situations where a professional interpreter was involved. In some cases, the doctors were forced to use relatives or a colleague to interpret, which in many cases proved to be a mistake. The consequences of poor interpretation routines included payment by mistake, a patient paying an interpreter who refused to interpret, time spent waiting for another interpreter, as well as disturbances to the daily work schedule. Finding someone who could replace an interpreter who did not show up caused time shortage and increased stress. Conclusions: Improved routines and more effective cooperation between interpreting services and health-care centers are needed in order to ensure that using professional interpreters guarantees appropriate, high quality care. Improvements are needed to provide satisfactory health-care to people with limited language skills. In order to achieve this, better education of interpreters is needed, especially regarding cultural diversity and medical terminology. These improvements present complex challenges, deserving empirical and critical reflection in order to improve the work situation for doctors.

Introduction Fractures of the radial head and neck are the most common fractures of the elbow, and account for approximately one-third of all elbow fractures. Depending on the fracture type the treatment is either conservative or surgical. There is no absolute consensus regarding optimal treatment for different fracture types. The aim of this protocol is to present the method that will be used to collect, describe and analyse the current evidence regarding the treatment of Mason II–III radial head and neck fractures. Method and analysis We will conduct a systematic review in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocol (PRISMA-P) guidelines statement. We will search a number of databases with a predefined search strategy to collect both randomised and non-randomised studies. The articles will be summarised with descriptive statistics. If applicable a meta-analysis will be conducted. Ethics and dissemination Ethical approval is not required since this is a protocol for a systematic review and no primary data will be collected. The authors will publish findings from this review in a peer-reviewed scientific journal. Trial registration number CRD42016037627.

A. BAJRAKTAREVIC, B. KRDZALIC, R. MERDZANIC, L. KUMASIN, A. SELIMOVIC, D. ABDUZAIMOVIC, A. ABDUZAIMOVIC, D. GRANOV ROKOLJ, I. SULJEVIC, H. CUBRO, F. KRUPIC Public Health Institution of Health Center Sarajevo, Pediatrics Department, Sarajevo, Bosnia and Herzegovina, Pediatrics Clinik Jezero, Pulmonology Departement, Sarajevo, Bosnia and Herzegovina, Private laboratory Jelah, Biochemistery Department, Tesanj, Bosnia and Herzegovina, Clinical Medical Center Sarajevo, Biochemistry and Microbiology Laboratory, Sarajevo, Bosnia and Herzegovina, and Institute of Clinical SciencesSahlgrenska AcademyUniversity of Gothenburg, Department of Orthopaedics, Gothenburg, Sweden

A. BAJRAKTAREVIC, B. KRDZALIC, R. MERDZANIC, L. KUMASIN, A. SELIMOVIC, D. ABDUZAIMOVIC, A. ABDUZAIMOVIC, D. GRANOV ROKOLJ, I. SULJEVIC, H. CUBRO, F. KRUPIC Public Health Institution of Health Center Sarajevo, Pediatrics Department, Sarajevo, Bosnia and Herzegovina, Pediatrics Clinik Jezero, Pulmonology Departement, Sarajevo, Bosnia and Herzegovina, Private laboratory Jelah, Biochemistery Department, Tesanj, Bosnia and Herzegovina, Clinical Medical Center Sarajevo, Biochemistry and Microbiology Laboratory, Sarajevo, Bosnia and Herzegovina, and Institute of Clinical SciencesSahlgrenska AcademyUniversity of Gothenburg, Department of Orthopaedics, Gothenburg, Sweden

IntroductionFemoral neck fracture (FNF) is a devastating injury with serious medical and social consequences. One-third of these patients have some degree of impaired cognitive status. Despite this, a high proportion of hip fracture trials exclude patients with cognitive impairment (CI). We aimed to evaluate whether moderate to severe CI could predict walking ability, quality of life, functional outcome, reoperations and mortality in elderly patients with displaced FNF treated with hemiarthroplasty (HA).MethodsThis cohort study included a consecutive series of 188 patients treated with HA for a displaced FNF. Patients were assessed for estimated preoperative and 1 year postoperatively with regard to walking ability, cognitive status, quality of life with EQ-5D and hip function with Harris hip score.ResultsThere were 188 patients who met the inclusion criteria. A total of 130 patients were in the control group, and 58 were in the CI group. At 1-year follow-up, 31 patients (24%) had died in the control group and 22 patients (38%) had died in the cognitive impaired group. This difference in reoperation and mortality rate was statistically significant (log-rank test, p = 0.016). The CI had a significantly higher incidence of being non-walker (28 vs. 4%, OR 9.2, p = 0.001). The EQ-5D was higher in the control group, while the Harris hip score was comparable in the two groups.ConclusionsModerate to severe CI was associated with a high incidence of non-walking ability, worse quality of life, high mortality and re-operation rate after femoral neck fractures treated with HA.

Introduction: Transplantation of organs is the treatment of choice for severe organ failure worldwide. Aim: The aims of the present study were to determine the influence of religion on attitudes towards organ donation among staff at schools in Tuzla. Material and Methods: In the Tuzla region there are 42 schools and 1580 school staff. A total of 21 schools were selected randomly, which were stratified by geographical location. 499 employees were invited to participate in the study, and 475 agreed to participate. According to the definition of their attitude towards religion the subjects were divided into three groups: non-religious, only religious and practical believers. Results: None of the subjects possesses a donor card. To the question whether the subjects support the idea of organ transplantation, most replied that they support the idea of donating organs both during life and after death. Regarding this question there is a significant difference between the groups (p = 0.0063). To the question whether they are prepared to donate an organ of a deceased family member, most replied that they would consent to donating an organ, whilst a significant number also replied that they were not sure. The results show that there is no significant difference between the replies given by the groups (p = 0.7694). To the question regarding to whom they were prepared to donate an organ, most said they were prepared to donate one to a member of their family, then to a close relative, whilst the least would donate to a stranger. The results show that there is a significant difference between the groups (p = 0.0002). Conclusion: In order to reduce the wide disparity between the need and organ donation amongst other things a more active relationship is necessary between health workers, religious officials and school staff.

We investigated if a femoral nerve block (FNB) for patients with a proximal femoral fracture (PFF) and administered by an orthopaedic registrar (OR) instead of an anaesthesiology registrar (AR) lowers the lead time to block and reduces the total amount of rescue analgesics during the preoperative phase. 205 patients were included in a prospective observational cohort study. The main outcome variable was rescue analgesics as total intravenous morphine prior to surgery. All results were adjusted for confounding using age, sex, cognitive dysfunction, and ASA classification. The OR group (n = 135) was over 2 hours faster in performing the block compared to the AR group (n = 70) but was nonetheless correlated with an increased amount of rescue analgesics during the study, 2.4 mg morphine (95% CI 0.0–4.9) more compared to the AR group. We found no difference between the groups in the risk of adverse events. We conclude that, for patients with an acute PFF and with morphine consumption as end point, how soon from arrival to hospital the patients receive a FNB is of lesser importance than who is administering it. Based on our results we recommend that emergency hospitals should have routines for anaesthesiologists performing FNB on this frail patient group.