ABSTRACT
Background: For patients undergoing surgery for peritrochanteric fractures, blood loss is a big issue. The purpose of this study was to see if tranexamic acid (TXA) could reduce postoperative blood loss in individuals who had hip surgery for peritrochanteric fracture. Methods: A total of 69 patients with intertrochanteric fractures were enrolled in this prospective study. Patients are randomly divided into two groups. Group A patients received 200 mL (1 g) of TXA intravenously before peritrochanter surgery and Group B patients did not receive an injection of TXA. Haemoglobin and hematocrit values were measured preoperatively and postoperatively at days 1 and 3. Visible and hidden blood loss volumes were calculated on postoperative day 3. Results: The blood transfusion rate was reduced significantly in patients by injecting tranexamic acid before surgery. However, mean haemoglobin and hematocrit levels were not significantly different between patients who received injection tranexamic acid and those who did not receive injection tranexamic acid. Conclusion: TXA significantly reduced postoperative blood loss in patients with Peritrochanteric fractures who underwent surgery.

ABSTRACT
Simultaneous bilateral acetabular fractures are extremely rare. The authors report a rare case of simultaneous bilateral acetabular fracture in an adult due to a road accident. Clinical diagnosis can be misleading in many patients seen in the context of polytrauma. Managing these fractures is a complex task that requires careful planning and surgical intervention, and the foremost goal of surgical intervention is to achieve an anatomically precise reduction of the fracture, as this factor greatly influences the future function of the hip joint.

ABSTRACT
Synovial chondromatosis (SC) is a rare disease. It is a chondrocytic metaplasia and is characterized by the presence of cartilaginous loose bodies in the involved joint, bursa or tendon sheath, it occurs most often in those aged 30_50 years and 3 times more in males than females, The shoulder is an exceptional location. It causes significant functional disability in young people. The clinical presentation is not specific, and the diagnosis is based on MRI. Confirmation is still anatomopathological. Classically, the mainstay treatment for SC of the shoulder has been open arthrotomy and removal of loose bodies, followed by either complete or partial synovectomy, removing the affected tissue, with recent advances in arthroscopic techniques and methods, arthroscopy becomes the gold standard. We present this case report of a 26-year-old man, who was left-hand dominant, a maintenance technician, amateur football player presented a left shoulder inflammatory pain; ; plain radiography demonstrated multiple calcific densities over the glenohumeral joint , the MRI showed multiple calcified intra-articular loose bodies around the anterior and posterior joint and axillary recess ; At arthroscopy, a large number of loose bodies were observed together with marked synovitis ,it only allowed the removal of small foreign bodies < 1 cm, partial synovectomy was performed with a shaver ; anatomopathological examination confirmed the diagnosis of sc. the extraction of giant fragments >2 cm was impossible so it was subsequently removed by open surgery. This was carried out one month later using a delto-pectoral approach: all foreign bodies > 1 cm were successfully extracted. We report this case report in order to review the role of shoulder arthroscopy and magnetic resonance imaging (MRI) in diagnosis and treatment and to highlight the operative difficulties, technical tips of arthroscopic extraction of giant Synovial chondromatosis of the shoulder.

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Objective: Clinical evaluation of atrophic rhinitis and comparative study of its surgical treatments. Materials and methods: This study was carried out in the Department of ENT, Dhaka National Medical Institute Hospital from June 2006 to May 2011 including the cases of atrophic rhinitis. A total of 40 patients of atrophic rhinitis were included in this study. Thirty-two patients had modified Young’s nostril closure and eight patients had dermofat graft obliteration of nasal cavity. Preoperative and postoperative assessment of nasal mucociliary flow rate were also assessed by saccharine test. Fifteen cases were kept in control group to compare the nasal mucociliary flow rate results. Results: The results of both surgical modalities were compared at various intervals for 20 months. Conclusion: The patients with history of nasal myiasis and septal perforation do better with partial nostril closure while patients, not having history of maggots and septal perforations, had best results with dermofat graft operation. It was seen that after surgical treatment of atrophic rhinitis, either by nostril closure or dermofat grafting, there was improvement in nasal mucociliary flow or, nearly, all patients were symptomatically improved.

ABSTRACT
Introduction: Paediatric femoral shaft fractures are common injuries in the age group treated by an orthopaedic surgeon. These fractures typically occur either in the early childhood when weak woven bone is changing to the stronger lamellar bone or at adolescence when children are subject to high energy trauma from motor vehicle accidents or from sports [1]. Femoral shaft fractures represent around 2.2% of all bony injuries in children. There are varieties of approaches to treat femoral fractures in the field of medical science. The aim of this study is to compare the outcomes between TENS and DCP approach for paediatric femur shaft fracture. Methodology: This was a prospective comparative study conducted at the department of Orthopaedics Surgery in Dhaka Orthopaedics Hospital, Dhaka, Bangladesh during December, 2017 to November, 2019. The ethical clearance of this study was obtained from the ethics committee of the hospital and a total of 23 children were enrolled in this study. The children were divided into two groups, TENS group n=14), DCP group (n=9). The collected data were analyzed using Statistical Package for Social Sciences (SPSS), software, version-23.0. Results: A total of 23 children aged 6-18 were enrolled in this study. Among the children 78 % were male and 22% were female. The mean age of the children was 10.7 years. In TENS group 9(63%) children fall from height and followed by 4(28%) got road traffic accident, and 1(7%) blunt trauma whereas in DCP group, 6(66%) fall from height and followed by 2(22%) got road traffic accident, and 1(11%) blunt trauma. In TENS group, 2(14%) children had radiologically comminuted fracture and followed by 3(21%) oblique, 9(63%) transverse whereas, in DCP group,1(11%) children had comminuted radiological fracture and followed by 2(22%) oblique and 6(66%) transverse In TENS group, the mean duration of surgery was 53.00 ±9.20 minutes while the mean duration of surgery in DCP group was 60.00±16.52 minutes, which was .....

ABSTRACT
Introduction: Acute haematogenous osteomyelitis (AHO) of the acetabulum is a rare condition in children. Presentation of case: We report a rare case in a ten-year-old child who had an acute presentation with new-onset hip pain and fever evolving for one week. The standard radiograph was without abnormalities. Emergency MRI showed osteoarthritis of the hip, with a 15 mm internal acetabular subchondral lacuna. Therefore, the child had antibiotic therapy. Pain relief and radiological improvement was obtained after 3 months of antibiotic treatment. At a two-year follow-up, the X-ray was normal. Discussion: Diagnosis is delayed because of the deep-seated location. Staphylococcus aureus is the most common causative organism. In the event of strong clinical-radiological suspicion, empirical treatment must be started rapidly, in order to obtain satisfactory results. Conclusion: Because of the atypical location of acute osteomyelitis of the acetabulum, diagnosis can be delayed. In some cases, treatment may be based on antibiotics therapy alone.

ABSTRACT
Lipomas are the most common benign form of soft tissue tumor in the body. Although they are commonly found on the upper extremity, their occurrence in the hand is rare. Giant lipomas of the hand, defined as >5 cm in diameter, are extremely rare. This manuscript reports a very rare case of giant lipoma on the palmar side of the hand in order to study the diagnostic, theurapeutic and prognostic aspects. A 61 year-old female had a large asymptomatic thenar swelling since 10 years. The clinical examination showed a subcutaneous tumor spreading the 1st commissure and making opposition of the thumb very limited. There were no inflammatory signs and no pain. The patient didn’t report any sensory deficit and the neurological examination was normal. The standard X-ray showed a tissue image without bone lesions. MRI demonstrated a large, well-limited T1, T2 hypersignal tissue formation, which developed in the subcutaneous fat of the first commissure, insinuated itself in front of the last three metacarpals, and included the deep and superficial flexor tendons. The patient was operated on under local anesthesia and pneumatic tourniquet at the root of the limb. The approach allowed a satisfactory exposure of the entire palm of the hand and revealed a lipomatous mass, encapsulated, pushing back the vascular and neural pedicles of the long fingers without invading them and remaining in front of the flexor tendons. The tumor was carefully dissected, which allowed it to be removed totally. Histology confirmed the diagnosis of benign lipoma. Complete recovery was achieved without any sign of recurrence during a follow up period of 5 years. Lipomas of the hand represent a rare benign tumor pathology; giant lipomas represent an exceedingly rare condition. The proximity of the relationships with the vascular and neural structures must lead to the greatest caution during surgical dissection. Only anatomopathological examinations confirm the histological nature of the lesion.