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
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
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
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
Neck pain is a prevalent mechanical musculoskeletal condition often linked to alterations in cervical lordosis, commonly resulting from poor posture, muscle imbalances, or degenerative changes. This commentary examines the role of conservative management strategies, including physical therapy, postural correction, and manual therapy, in restoring and maintaining the natural curvature of the cervical spine to alleviate pain. Additionally, it highlights the role of advanced spinal assessment tools, particularly Nordic health devices, which provide precise, quantifiable data on cervical spine alignment, range of motion (ROM), and muscle imbalances. Key outcome measures, such as the Numeric Pain Rating Scale (NPRS), Cobb’s angle, and the Neck Pain and Disability Index (NPAD), facilitate the evaluation of pain severity, spinal alignment, and functional impairment in individuals with neck pain. By leveraging these technologies, objective data can be gathered to identify abnormal spinal curvature and muscle imbalances, enabling the development of personalized rehabilitation programs. The integration of conservative therapy with device-assisted spinal screening offers a comprehensive, evidence-based approach to managing cervical lordosis and mitigating neck pain, with continuous monitoring ensuring sustained treatment effectiveness.

ABSTRACT
Background: Low back pain (LBP) is the fifth most common reason for hospital visits, which affects nearly 60-80% of people throughout their lifetime (Tillotson, 1995). The prevalence of low back pain is reported to be as high as 84%, and the prevalence of chronic low back pain is about 23%, with 11-12% of the population being disabled by low back pain (Koes, 2006). According to Damian (2014), In the 2010 Global Burden of Disease study the global age-standardised point prevalence of LBP (from 0 to 100 years of age) was estimated to be 9.4%. The same study showed that prevalence in 2010 was highest in Western Europe followed by North Africa/Middle East, and lowest in the Caribbean followed by central Latin America. Aim: The purpose of this study is to ascertain the level of tumour necrosis factor, physical activity and body adiposity in patients with non-specific chronic low back pain in relation to their apparently healthy counterparts between the age of 30 to 60 years in River’s state. Methodology: This is a quasi-experiment / cross sectional research design. Those that agreed to participate were included and they were selected randomly. All Patients with Non-specific chronic low back pain within the ages of 30 - 60, that complained of pain within 6 months, without any history of spinal decompression, non-pregnant women who presented with low back pain, who presented for treatment at the hospital participated in the study for the period of 6 months. Subjects with a history of heart disease, hypertension, diabetes, Pott’s disease, and use of drugs like steroids and pregnant women was excluded from the study because the cause of their back pain is known. Also, some of their back pain is temporary. They were of 2 groups. First group are the patients diagnosed of non-specific chronic low back pain and the second group are the apparently healthy individuals that serve as control. Their blood samples were taken by the lab scientist. and sent for analysis.