ABSTRACT
Fibular head avulsion fractures are rare injuries that often reflect significant trauma to the posterolateral corner of the knee. This case report presents two adult patients with avulsion fractures of the fibular head, both involving lateral collateral ligament damage. The first case involved bilateral knee trauma after a motor vehicle accident, while the second resulted from a sports-related injury. Diagnosis was confirmed via imaging, including identification of the "arcuate sign" on radiographs and 3D CT scans. Surgical management through direct screw fixation was performed in both cases, followed by structured rehabilitation. At one-year follow-up, both patients showed complete recovery with restored knee stability and full range of motion. This report highlights the importance of early recognition and comprehensive treatment to prevent long-term posterolateral instability and functional impairment.

ABSTRACT
Ring finger avulsion is a rare but severe hand injury, typically caused by a ring catching on a fixed object during a fall or sudden traction. This retrospective study analyzes seven cases treated at the Mohammed V Military Teaching Hospital between 2017 and 2021. All patients were male military personnel presenting with complete amputation of the left ring finger, classified as Urbaniak stage III. Each underwent surgical management with Chase amputation and medialization of the ring finger. Surgery was performed within an average of 12 hours post-injury. Early rehabilitation was initiated to optimize functional recovery. After a two-year follow-up, all patients achieved satisfactory functional and aesthetic outcomes. The Chase technique, which repositions the middle finger to replace the ring finger, offers a reliable solution when replantation is not possible. This study highlights the need for early intervention, proper rehabilitation, and increased awareness of preventive measures, especially in high-risk occupational settings.

ABSTRACT
Background: Supracondylar fractures are the most common elbow fractures in children, with Gartland type II fractures posing treatment controversies regarding conservative casting versus operative fixation. Optimal management remains debated to achieve the best functional and radiological outcomes while minimising complications. Aim of the Study: The aim of this study was to compare conservative casting and operative treatment by K-wire in Gartland type II supracondylar fracture in children. Methods: This observational comparative study was conducted in the Department of Orthopaedics, President Abdul Hamid Medical College Hospital, Kishoreganj, Dhaka, Bangladesh from January 2024 to May 2025. This study includes 50 paediatric patients presenting with Gartland type II supracondylar fractures of the humerus. The participants were divided into two groups each containing 25 patients: Group a included patients treated with conservative casting and Group B include patients treated with K-wire fixation. Result: Excellent outcomes were observed in 64% of Group A and 80% of Group B. The operative group showed significantly better extension recovery (mean extension lag: 2.2° vs. 3.4°, p=0.01). Baumann’s angle, flexion range, and fracture union times were similar between groups. Hospital stay was significantly shorter in the conservative group. Complications differed, with loss of reduction and malunion in Group A, and pin site infections and nerve injuries in Group B. Conclusion: Both conservative casting and operative K-wire fixation are effective for Gartland type II fractures. Operative treatment showed trends towards better extension outcomes and fewer reductions lost, while conservative management effectively avoided surgical risks with reduced hospital stay.

ABSTRACT
Background: Few studies have investigated which of the classification systems between Dimeglio and Pirani best correlates with the number of casts required to achieve clubfoot correction. This study aims to analyse the two scoring systems to determine the best in predicting number of casting sessions required for idiopathic clubfoot correction. Objectives: To determine the correlation between the Pirani and Dimeglio scoring systems with the number of casts required for correction of idiopathic clubfoot using Ponseti method of treatment. Material and Methods: This work was a 12 months prospective interventional study. 55 Patients with 94 idiopathic clubfeet who met the selection criteria and consent given by their Parent/guardian were recruited for the study. Each clubfoot was scored at presentation using the Pirani and Dimeglio scoring systems. All clubfeet were treated using the Ponseti method until correction was achieved (with or without percutaneous tenotomy). The correlation between the two scoring systems and the number of casts required to achieve correction was analysed. Results: The mean number of casts required to achieve initial correction was 4.38 (range: 2-7). There was a positive correlation between the Pirani scores at presentation (r=0.854, p=<0.001) and the Dimeglio scores at presentation (r=0.809, p=<0.001) with the number of casts required to achieve correction. Multiple linear regression analysis showed that the Pirani score at presentation significantly predicts the total number of casts better than Dimeglio scores. Conclusion: The Pirani score showed better accuracy in predicting the total number of casting sessions required for correction of idiopathic clubfoot.

ABSTRACT
Patellar fractures, which compromise the knee's extensor mechanism, are commonly encountered orthopedic injuries. Tension band wiring (TBW) is the standard approach for managing simple transverse fractures but is not without complications such as wire migration and breakage. This case report introduces a modified TBW method intended to enhance mechanical stability and mitigate common hardware-related issues. A 51-year-old woman presented with right knee pain and swelling after a fall. Radiographs showed a transverse patellar fracture. She underwent surgical fixation using a triple-bundle wire technique designed to boost construct integrity and prevent wire migration. Postoperative management involved early mobilization with continuous passive motion and gradual progression to full weight-bearing. At a three-month follow-up, the patient exhibited complete fracture healing and excellent knee function, with no implant-related issues. This modified TBW approach proved to be biomechanically stable, safe, and conducive to early recovery, warranting consideration for wider clinical application.

ABSTRACT
This study examines the effects of diet and physical activity on the well-being of older people in Abidjan, by comparing institutional norms and real-life experiences. The aim is to analyse how these practices influence the physical, psychological and social health of older people, in a context of changing diets and unequal access to sports facilities. The triangulated qualitative approach involves semi-structured interviews with senior citizens from a variety of backgrounds, ethnographic observations in sociable spaces (markets, sports clubs, health centres) and an analysis of institutional discourse on active ageing. The results show that while certain dietary and sporting practices enhance autonomy and socialisation, economic constraints, cultural perceptions and infrastructure deficits limit their adoption. The discussion highlights the tension between globalised prescriptions and local roots. In conclusion, it appears essential to adapt public policies to the realities of the Ivory Coast in order to promote inclusive active ageing.

ABSTRACT
Background: Transverse acetabular fractures often involve the weight-bearing dome of the acetabulum and require precise anatomical reduction for optimal functional recovery. Open reduction and internal fixation (ORIF) using the Kocher-Langenbeck approach remains a preferred method for managing such injuries. This study aimed to evaluate the functional outcomes following ORIF of transverse acetabular fractures using this posterior approach. Methods: This prospective observational study was conducted in the Department of Orthopaedic Surgery at Dhaka Medical College Hospital over 24 months from July 2017 to June 2019. A total of 25 patients aged 21–80 years with radiologically confirmed transverse or associated acetabular fractures were included. All underwent ORIF through the Kocher-Langenbeck approach within three weeks of injury. Functional outcomes were assessed using the Merle d’Aubigné and Postel scoring system at six months postoperatively. Results: The mean age of patients was 36.2 ± 14.12 years, with most (76.0%) between 20–40 years. Anatomical reduction was achieved in 80.0% of cases. At six months, 40.0% of patients had excellent, 20.0% good, 4.0% fair, and 36.0% poor outcomes. Overall, 76.0% had satisfactory outcomes. Pain-free status was observed in 76.0%, normal walking in 76.0%, and 95%–100% hip range of motion in 60.0% of patients. Functional outcome showed a significant distribution difference (p = 0.021), though not significantly associated with reduction quality (p > 0.05). Conclusion: ORIF through the Kocher-Langenbeck approach provides favorable functional outcomes in the majority of patients with transverse acetabular fractures.

ABSTRACT
Giant cell tumour (GCT) of bone is a benign but locally aggressive neoplasm, frequently involving the epiphyseal region of long bones, particularly around the knee [1-3]. We report a case of GCT of the right proximal tibia in a skeletally mature patient who presented with pain and swelling. Radiological evaluation showed a well-defined expansile lytic lesion without evidence of metastasis [1-4]. The patient was managed with extended intralesional curettage using a high-speed burr, adjuvant chemical cauterisation, and defect reconstruction with polymethylmethacrylate (PMMA) bone cement [3, 4]. Post-operative recovery was uneventful, with excellent knee function and no recurrence at follow-up. Bone cement provided immediate stability, enabled early mobilisation, and facilitated detection of recurrence on imaging [4, 5]. This case highlights that extended curettage with adjuvant therapy and cement reconstruction is an effective joint-preserving technique for proximal tibial GCT, offering good functional outcomes and low recurrence rates [3–5].

ABSTRACT
Methicillin-resistant Staphylococcus aureus (MRSA) osteomyelitis is difficult to treat due to multidrug resistance, biofilm formation, and the need for prolonged intravenous therapy. This observational study involved 14 patients (6 chronic osteomyelitis, 8 septic non-union; age 14–78 years), all with MRSA sensitive only to vancomycin. Treatment included surgical debridement, high-dose local vancomycin via polymethylmethacrylate (PMMA) beads or coated nails, and a short intravenous vancomycin course with oral linezolid in selected cases. All patients achieved infection cure; fracture union occurred in all septic non-union cases, with no systemic toxicity. High local antibiotic delivery improved outcomes and reduced hospitalization, though PMMA required secondary removal. Dual mode vancomycin therapy appears effective for MRSA osteomyelitis and septic non-union, but larger controlled trials are needed for validation.

ABSTRACT
Introduction: Recurrent patellofemoral instability is a frequent condition in young, active individuals. It results from anatomical and biomechanical factors such as trochlear dysplasia, an increased Q angle, or a lateralized tibial tubercle. Surgical treatment may involve tibial tubercle transposition (TTT) to realign the extensor apparatus and improve patellar tracking. Objective: To report the clinical and radiological outcomes of two patients treated with medial tibial tubercle transposition for recurrent patellar dislocations. Case Reports: Case 1: A 19-year-old female athlete with a 3-year history of recurrent right patellar dislocations. CT scan revealed a TT–TG (tibial tubercle–trochlear groove) distance of 24 mm. A medial tibial tubercle transposition using the Elmslie-Trillat technique was performed. Case 2: A 22-year-old male with bilateral subluxations and significant functional limitation. MRI showed type B trochlear dysplasia (Dejour classification) with a TT–TG distance of 22 mm. Anteromedial transposition combined with MPFL reconstruction was performed. Results: At 12 months postoperative, both patients showed clinical stability with significant improvement in Kujala scores (>85). No recurrence of dislocation was reported, and anterior knee pain had resolved. Conclusion: Tibial tubercle transposition is a reliable technique in the surgical management of recurrent patellar instability, particularly when TT–TG distance is increased. It may be combined with additional procedures depending on associated anatomical abnormalities.

ABSTRACT
Objective: To describe the diagnostic and therapeutic aspects of patellar tendon rupture and to report two cases treated by primary suture protected with a semitendinosus–gracilis (DIDT) autograft frame. Methods: Two patients with traumatic patellar tendon rupture underwent surgery using the same technique: primary repair and protective autologous DIDT frame. A literature review was performed to define the role of this technique. Results: Both patients regained full active extension and satisfactory knee mobility at 6 months, without major complications. Literature data report a success rate above 90% with this method. Conclusion: Patellar tendon repair protected by a DIDT frame is a reliable technique, allowing early mobilization and reducing the risk of rerupture.

ABSTRACT
Dupuytren's disease is a chronic fibroproliferative disorder of the palmar fascia leading to progressive flexion contractures of the fingers, most often affecting the ring and little fingers. This condition predominantly affects men over the age of 50 and has a multifactorial etiology involving genetic predisposition and environmental risk factors such as manual labor and alcohol consumption [1, 2]. We report four clinical cases treated at the CHU de Rabat to illustrate the spectrum of presentations and therapeutic outcomes. All patients underwent surgical management with open fasciectomy. The procedures resulted in functional improvement without significant complications. A structured postoperative rehabilitation program was followed, contributing to satisfactory recovery. Non-surgical treatments such as collagenase injections may be effective in selected early-stage cases but were not applied in our series [3, 4]. The choice of therapy must be tailored according to disease severity and patient function. Surgical excision remains the standard in advanced stages, especially when deformities impair daily activities [2-5]. Follow-up is essential to monitor recurrence, which remains a challenge despite optimal management. This series emphasizes the importance of early diagnosis, patient education, and coordinated multidisciplinary care in optimizing outcomes.

ABSTRACT
Background: Radial head subluxation, also known as “nursemaid’s elbow,” is a common injury in children under the age of six, typically caused by axial traction on the forearm. Its occurrence in adolescents is exceedingly rare, often leading to misdiagnosis. This case highlights an unusual presentation of recurrent elbow pain in an adolescent patient, ultimately confirmed as a missed radial head subluxation. Case Presentation: A 13-year-old adolescent presented to an outpatient clinic with recurrent episodes of right elbow pain and functional limitation after minor traction injuries, such as being pulled by the arm during play. The pain was described as acute, sharp, and associated with limited supination, but without swelling, bruising, or deformity. Initial evaluations elsewhere had diagnosed the condition as a soft tissue strain, and the patient had been treated with analgesics and rest without significant improvement. On examination, the elbow showed tenderness over the lateral aspect and restricted supination, but radiographs revealed no evidence of fracture or dislocation. A clinical diagnosis of radial head subluxation was considered despite the patient’s atypical age. Closed reduction was performed using the supination-flexion technique, producing an audible “click” and immediate pain relief. At follow-up, the patient remained asymptomatic, with no recurrence after initiation of a physiotherapy program focusing on strengthening and ergonomic education. Conclusion: This case emphasizes that radial head subluxation, although rare in adolescents, should remain a differential diagnosis for recurrent elbow pain following minor traction injuries. Awareness of this atypical presentation in outpatient practice can prevent unnecessary imaging, inappropriate management, and prolonged morbidity. Prompt recognition and simple reduction techniques remain highly effective, while physiotherapy plays a key role in preventing recurrence.

ABSTRACT
Low-velocity tibial plateau fractures are not very comminuted and classically involve the lateral tibial plateau. The aim of this study was to present the anatomical and functional results of surgical treatment of external tibial plateau fractures classified as Schatzker types I, II and III. This was a cross-sectional study with prospective data collection, involving 33 patients. Functional results were assessed by the Lysholm score, and anatomical results by the Duparc and Cavagna criteria. The mean age of patients was 44.7 years, with a predominance of males (sex ratio 3 (25H/8F)). Road traffic accidents were the most frequent etiology, occurring in 28 patients (84.8%). Schatzker type I fractures were the most frequent, with 14 cases (42.4%). Osteosynthesis with a screw plate was the most common method of fixation in 15 patients (45.5%), followed by percutaneous screw fixation under fluoroscopic control in 13 cases (39.4%). The mean follow-up was 44.09 months. The mean Lysholm score for functional results was 90.09/100. Osteosynthesis using screw plates and percutaneous screw fixation under fluoroscopic control remains an effective therapeutic approach with good results.

ABSTRACT
The femoral offset is the most important prognostic element in hip arthroplasty. Its restoration is crucial. Any change in the native value of the offset affects the quality of clinical function of the hip. The aim of our study was to evaluate the clinical function of the hip based on the value of the femoral offset after arthroplasty. This is a retrospective study conducted between 2010 and 2013, involving 27 patients who underwent total hip arthroplasty. Patients who had previous surgical procedures on the same hip or on the contralateral hip were excluded. Measurements were taken from standard hip radiographs in approximately 15° internal rotation, with magnification at 100%. Clinical results were assessed using the WOMAC score, which averaged 15.2 points, and the Merle d'Aubigné-Postel score, with an average of 15 points. Two other tests were also evaluated in our study, the step and hop tests were used. The best functional results were obtained in patients who had a lateralization of the femoral stem with an increased offset.

ABSTRACT
Fractures of the upper end of the humerus pose a therapeutic problem, particularly for complex fractures with 3 and 4 fragments. The objective of this study is to determine the epidemiological-clinical characteristics of complex fractures of the upper end of the humerus in adults and to assess the functional and radiological outcomes of our series. This series consists of 15 cases collected at the orthopedics department of CHU Ibn Sina between 2021 and 2015. We recorded the epidemiological data of the patients and the circumstances of the trauma. The treatment was primarily surgical, either plate synthesis or nail fixation. The reduction was evaluated based on postoperative X-rays. At follow-up, functional results were assessed using the Constant score. Our series includes 8 men and 7 women, with an average age of 57 years; traffic accidents were noted in 48% of cases, and 4-fragment fractures were found in 76%.des cas. Plate osteosynthesis was used in 40% of cases and anterograde nailing was performed in 40% of cases. The average Constant score was 65.24 with extremes ranging from 35 to 88. We noted consolidation of fractures without malunion in 68%. In complex fractures of the proximal humerus, appropriately indicated osteosynthesis based on the patient and the fracture, along with early postoperative rehabilitation, results in acceptable functional outcomes.

ABSTRACT
Scaphoid fractures are difficult to diagnose and treat. The authors report the results of treating these fractures with percutaneous screw fixation using the Herbert screw. The results were interesting given the rapid consolidation and the quality of the functional outcome.