ABSTRACT
Dorsal dislocations of the metacarpophalangeal joint of the thumb are rare. Complex dorsal dislocations are defined by the entrapment of the sesamoid bones and the soft tissue, such as the volar plate, behind the phalanx at the level of the metacarpal neck. These cases often necessitate open reduction. We present the case of a 22-year-old male patient who was admitted to our institution with a dorsal metacarpophalangeal dislocation of the thumb. Surgical reduction was required following the failure of closed reduction attempts.

ABSTRACT
Background: Failed Back Surgery Syndrome poses a significant challenge due to persistent pain following spinal surgery, greatly affecting patient quality of life and healthcare resources. Objective: This study aims to evaluate the effectiveness of revision spine surgery in FBSS patients, identifying key predictors for improved clinical outcomes. Method: A prospective study was conducted at a tertiary-level hospital in Bangladesh, involving 98 FBSS patients undergoing revision spine surgery from June 2020 to June 2023. Outcome measures included pain reduction (Visual Analog Scale), functional improvement (Oswestry Disability Index), and patient-reported quality of life. Result: Six months post-surgery, 74% of patients experienced clinically significant pain reduction (>50% on VAS), while 63% showed notable functional improvement with a reduction in ODI scores of over 40%. Quality of life improved for 68% of patients, with 25% reporting a complete return to daily activities. Among surgical types, decompression led to a 58% improvement in mobility, while fusion procedures resulted in a 70% pain reduction. However, 12% of patients reported little to no improvement, and 5% experienced worsened symptoms, underscoring the variability in outcomes. Predictive success factors included shorter intervals between surgeries and lower initial pain levels (p < 0.05). Overall, revision surgery was beneficial for the majority, but not all patients achieved desired outcomes. Conclusion: Revision spine surgery in FBSS patients can lead to significant improvements, though outcomes vary. Identifying predictive factors is essential to guide surgical planning and enhance patient selection.

ABSTRACT
Joint fractures of the base of the fifth metacarpal are rare injuries but they can cause serious complications if poorly managed, such as weak grip strength and wrist extension, decreased range of motion, osteoarthritis, tendon rupture, and carpal instability. We focus on two entities, Bennett and Rolando fractures regarding their mechanisms and tendency to instability. Their treatment remains a controversial subject. Through a series of 13 joint fractures of the base of the fifth metacarpal collected between December 2022 and June 2023 treated in the Orthopedic Department of Ibn Sina Hospital in Rabat, and a review of the literature, we review the data on anatomy, biomechanics, pathophysiology, diagnostic and therapeutic means and the prognosis of Bennett fractures by showing the benefit of osteosynthesis by Iselin double intermetacarpal pinning

ABSTRACT
Background: Delayed union fractures pose a significant clinical challenge, often requiring enhanced treatment modalities to accelerate healing and improve patient outcomes. Various techniques, including autologous bone grafting and biologic agents like platelet-rich plasma (PRP) and bone morphogenetic proteins (BMPs), have been employed to stimulate bone regeneration. However, the optimal approach remains debated. Objective: This study aimed to compare the efficacy of autologous bone grafting, biologic agents, and combined therapies in promoting fracture healing, reducing pain, improving functional outcomes, and enhancing patient satisfaction in delayed union fractures. Methods: A prospective study was conducted on 80 patients with delayed union fractures. Patients were randomly assigned to one of four groups: standard care (control), autologous bone grafting, biologic agents (PRP and BMPs), or a combination of bone grafting and biologic agents. Radiographic healing was assessed at 6, 12, and 24 weeks. Pain intensity was measured using the Visual Analog Scale (VAS), functional outcomes were assessed using the AAOS lower limb function scale, and patient satisfaction was evaluated using a Likert scale. Results: The combined therapy group exhibited significantly faster radiographic healing, with 80% of patients showing callus formation at 6 weeks and 95% achieving complete union at 24 weeks, compared to 35% in the control group. The combined group also reported the greatest reduction in VAS pain scores, with a mean decrease from 7.8 to 1.5 at 24 weeks (p<0.001). Functional outcomes were significantly improved in the combined group, with a mean AAOS score of 100 at 24 weeks, compared to 70 in the control group (p<0.001). Additionally, 90% of patients in the combined group reported high satisfaction, compared to 40% in the control group. Conclusion: The combination of autologous bone grafting and biologic agents, such as PRP and BMPs, significantly accelerates ..........

ABSTRACT
Isolated acute dislocation of the distal radioulnar joint is a rare lesion, and in 50 % of cases goes unrecognized; it may be palmar or dorsal. Its diagnosis is suspected when the wrist is traumatic, painful, with limited pronosupination and no fracture on radiological examination. Treatment is aimed at preventing the development of chronic instability and/or arthrosis, and consists of reduction followed by immobilization.

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This article focuses on pleomorphic sarcomas, which are malignant mesenchymal tumors with a complex genetic background underlying their morphological pleomorphism. These are poorly differentiated tumors that can maintain different lines of differentiation, sometimes correlating with clinicopathological or prognostic characteristics. Accurate diagnosis in this group of tumors relies on adequate sampling due to their heterogeneity and evaluation by both microscopy and large immunohistochemistry panels. Molecular analyzes have a limited role in their diagnosis as opposed to translocation-related sarcomas, but they may provide important the anotic and prognostic information in the future.

ABSTRACT
Introduction: Pancoast-Tobias tumor (PTT), is a rare presentation of lung cancer that affects less than 5% of patients. Vertebral hemangioma is a benign tumor that develops in the endothelial lining of blood vessels. It is rarely symptomatic in adults, with only 0.9 to 1.2% of all vertebral hemangiomas being symptomatic. Materials and Methods: A 69 years old patient presented with right-sided chest pain, cough but no dyspnea associated with a weight loss of 10 kg over the past 06months. The patient reported inflammatory back pain that had been evolving for 2 years and had worsened in recent months. Chest X-ray-CT scan and MRI revealed a tumor mass in the apical segment of the right upper lobe extending into the right posterior mediastinal space at the costo-vertebral groove, measuring 38*33 mm with D2 and D3 vertebral body nodule in T1 isosignal, T2 hypersignal enhancing after gadolinium injection, consistent with an aggressive vertebral angioma (AVA). A multidisciplinary approach was organized, and the indication was to perform preoperative embolization, followed by hemivertebrectomy of D12 associated with costolobectomy. The patient refused to continue the treatment and passed away after 05 months. Discussion: Most vertebral angiomas are discovered incidentally and should not be treated. Pain is generally the most common symptom of discovery. MRI remains the most effective in exploring vertebral angiomas. PTT can extend to the cervicothoracic outlet, the diagnosis of these tumors calls for chest X-ray. Thoraco-abdomino-pelvic CT scan is part of the extension assessment and MRI allows for precise analysis. The management of the exclusive association of PTT and AVA remains a a challenge. Conclusion: The combination of PTT and a set of AVA is extremely rare and doesn’t appear to be described in the literature. The central problem remains the management, which is a challenge for the responsible surgical team.