ABSTRACT
Abstract: The ipsilateral fractures of the femur and tibia, or floating knee, is a rare injury that is observed almost exclusively in patients with multiple trauma or during high-energy trauma. It include a combination of diaphyseal, metaphyseal and intra-articular fractures of the femur and tibia, with a high incidence of neurovascular, ligament and soft tissue damage. Our work is a retrospective study of 40 patients with floating knees. The circumstances of the fractures are dominated by young men victims of road accidents with an average age of 28 years, the floating knee was part of a severe multiple trauma in 25% of cases, Open fractures represent 71.42% of cases. 71.43% of patients represent type I fractures according to FRASER classification and associated ligament injuries are found in 12.5% of cases. Intramedullary nailing has been the most frequently used method for the osteosynthesis of both bones. The prognosis of these fractures depends mainly on the age, the anatomo-pathological type, the associated lesions and the quality of the treatment.

ABSTRACT
Abstract: Introduction: Femoral shaft fractures are most common fractures in paediatric age group having different options to treat them. Elastic stable intramedullary nailing is one for treating these fractures and has a reliable methodology. Objective: The aim of this study is to evaluate the Short Term Outcome of Closed Intramedullary Fixation with Titanium Elastic Nail in Displaced Femoral Shaft Fractures in Skeletally Immature Children. Material and Methods: 36 femoral shaft fractures in 36 children aged 6-14 years were fixed with titanium intramedullary elastic nail between July 2017 and December 2018 in the department of Orthopaedics, Rajshahi Medical College Hospital & Royal Hospital Ptv. Ltd. Rajshahi, Bangladesh. Results: All patients achieved complete healing at a mean of 9.1 (Range 810) weeks. 31 fractures were reduced by closed means but 5 needed open reduction. No major complication was recorded. Most common minor complication was entry site skin irritation recorded in 4 patients. 86% had excellent result and 14% had satisfactory. Conclusion: Elastic stable intramedullary nailing is the method of choice for the femoral shaft fractures in paediatric patients, because it is minimally invasive and shows very good functional and cosmetic result. It allows early ambulation and shorter hospital stay and higher parent satisfaction. It also provides flexural, translational and rotational stability as well.

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Abstract: The trapezo-metacarpal dislocation is an uncommon event. Usually caused by indirect mechanism. We present a case of a 26-year-old man patient who developed a chronic instability of the right thumb carpometacarpal joint, after two episodes of recurrent dislocation. The patient underwent rewarding management by Eaton-Littler's ligamentoplasty technique using flexor carpi radialis tendon. Functional result was satisfactory.

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Abstract: Background: In era of increased air travel, airport security screening measures has been increased. A lot of anxiety to the patient that may trigger an alarm at airport securities post-surgery. The purpose of this study is to find out experiences of patients after total knee arthroplasty (TKA) passing through airport security. Methods: A retrospective case series of 250 TKA patients in a single high-volume center from January 2017 to January 2019, who had passed through airport security and met inclusion criteria. Patients were contacted during their regular follow ups or via phone. The patients were asked for alarm trigger, perceived inconvenience, whether security officials asked to show documentation regarding prosthesis, and any extra screening procedures check measures. Results: Out of 250 patients, 52 patients met inclusion criteria travelling by airplane. 27 patients reported alarm trigger. 7 patients had to undergo additional security check measures. 43% of the patients believed that having their TKA increased the inconvenience while traveling. Conclusions: This study provides information to surgeons regarding airport travel post TKA. Patients can be counselled regarding the inconvenience and to be prepared for delays in airport and to be prepared to present documentation of their prosthesis.

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Abstract: Osteochondroma is a developmental anomaly of the bone that results in the formation of an exophytic outgrowth on the surface of the bone. It is the most common benign bone tumor. Distal Femur and Proximal Tibia are the most common sites for this tumor. Osteochondroma is rare in the Pelvis. Osteochondroma is also known as Exostosis. We hereby report a case of solitary osteochondroma from the Anterior Superior Iliac Spine in a 22-year-old boy which was managed in our Centre.

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Abstract: Anxiety is the commonest anticipated problem of patients during the perioperative period. Preoperative anxiety can produce poor postoperative outcome and make the management and control of postoperative pain more difficult. Studies have demonstrated a strong relationship between anxiety and pain. Anxiety leads to elevated pain, likewise pain results in an increased level of anxiety. Therefore, it can be postulated that reducing the amount of anxiety experienced preoperatively with an anxiolytic will reduce the burden of pain experienced by patients postoperatively. This study assessed the clinical effect of preoperative anxiolysis with Lorazepam on postoperative pain perception in patients undergoing elective lower limb major orthopaedic surgeries under combined spinal epidural (CSE) anaesthesia. This was a prospective study of 122 patients who presented for surgeries at the University of Abuja Teaching Hospital, Nigeria. Patients were randomly assigned to receive either Lorazepam 2mg (n=56) or placebo (n=56) the night before surgery and 2h before scheduled surgery. Postoperative pain scores, analgesic requirements and satisfaction with pain control were evaluated during the first 24h following surgery.We found that patients who received Lorazepam reported a significantly lower pain score than placebo group during the first12h (p= 0.031) while morphine requirement was significantly greater in the placebo group than Lorazepam group (8.20±1.91mg vs 14.8 ±2.10mg; p= 0.036) and patients treated with anxiolytics showed a greater satisfaction with pain relief (p=0.0185). In summary, preoperative Lorazepam produced significant anxiolysis that led to reduced pain, lower analgesic consumption, and better satisfaction but with modest side effects.

ABSTRACT
Background: The argument on whether extracorporeal shock-wave therapy (ESWT) proves to be beneficial in short- term intervention in adults with plantar fasciitis. It is important and necessary to conduct a meta-analysis to make a comparatively more reliable and overall assessment about the outcomes of ESWT in the less than 6 months. Methods: we conducted A Systematic Review and meta-analysis of randomized control trials from MEDLINE, Embase and CINAHL database from 2000 to 2020. We included randomized trials which evaluated extracorporeal shock wave therapy used to treat plantar heel pain. Trials comparing extra corporeal shock wave therapy with placebo were considered for inclusion in the review. We independently applied the inclusion and exclusion criteria to each identified randomized controlled trial, extracted data and assessed the methodological quality of each trial. Results: Four studies involving 645 patients were included. 3 RCTs (n=605) permitted a pooled estimate of effectiveness based on overall success rate and composite score of visual analogue scales for pain at the follow-up 1 (12 Weeks) .The pooled data showed no significant heterogeneity at three-month follow-up (p-value of chi-square = 0.61 P=0.74 and I2 = 0%). The ESWT group had a better success rate than the control group at three-month follow-up (OR = 2.26, 95% CI = 1.62-3.15, p < 0.00001). For reduction of pain the pooled data showed no significant heterogeneity (P Value of chi-Square 0.28 and I2 22% ) There were significant differences between the ESWT and control groups for all the follow-up visits (random-effect model, three trials, MD = 15.14, 95% CI = 13.86 to 16.42, P <0.00001 at three-month). Conclusion: A meta-analysis of data from three randomized-controlled trials that included a total of 605 patients was statistically significant in favour of extracorporeal shock wave therapy at follow-up 1(12 weeks).