ABSTRACT
Bilateral shoulder dislocation is rare, and often posteriorly directed. Bilateral symmetric anterior shoulder dislocation is all the more rare. Its mechanism can be due to fall in an unconscious state or due to the contraction of the pectoralis and latissimus against an unyielding arm. We report a rare case of bilateral symmetric anterior shoulder dislocation with associated bilateral fracture of the greater tuberosity caused by violent muscle contractions during sleep, as part of the rapid eye movement sleep behaviour disorder. This trauma circumstance has never been reported in the literature, to our knowledge. The diagnosis was suspected clinically and confirmed by standard radiography and CT scan. The Bilateral dislocation was managed by closed reduction, and the associated bilateral greater tuberosity fracture had internal fixation by screws. The anatomical and functional result was satisfactory after three months postoperatively. Through this case, we wanted to draw the attention of orthopaedic surgeons to this pathology which is rarely missed in trauma condition, but it can be missed in non-traumatic and involuntary muscular contraction conditions.

ABSTRACT
Chronic Low Back Pain (CLBP) is a common health concern worldwide. It is the most prevalent musculoskeletal problem and one of the most common causes of disability in developed nations. This study was conducted to determine the clinical patterns and associated factors of CLBP in patients who are attended at the Orthopaedic Clinic of the Bugando Medical Centre, Mwanza Tanzania in order to assist in designing CLBP preventive measures. This was cross-sectional analytical study conducted between July 2019 and November 2019 in the Orthopaedic Clinic of Bugando Medical Centre and a structured questionnaire was used for data collection. A total of 228 candidates were enrolled in the study. Majority of the candidates were male 141 (61.84%), the mean age of the candidates was 51.8 (±14.2). Two hundred and twenty five (98.68%) candidates had CLBP on exertion with 192 (84.21%) candidates experienced radicular neuropathic pain to the lower limbs. Severity of CLBP was significantly associated (p< 0.05) with age group, marital status, occupation, previous back pain, prolonged static work posture, heavy physical work and obesity. All candidates had some functional disability with the majority presenting with moderate functional disability. CLBP mostly affects mostly males in the working age group with majority presenting with pain on exertion and radicular neuropathic pain to the lower limbs. Appropriate measures should be taken to prevent CLBP including ergonomic assessment of the home and work place as well as routine public health promotions on appropriate back postures and uses.

ABSTRACT
Ainhum is a constricting band disease of unknown aetiology. It is a rare disease and progressed by constricting fibrotic bands over the digits that may lead to auto amputation. It is classified as pseudoainhum with the known secondary cause or trauma [1]. It is prevalent worldwide but most commonly found in African countries. It is not a usual presentation in Qatar (Middle East), and our patient is ethnically of Indian origin but residing here for the past decade. The case is a unique opportunity that highlights the challenges of early diagnosis and timely treatment to prevent complications such as toes amputation.

ABSTRACT
Fracture Disease is rare avascular necrosis following the immobilization of fractures occurs often in older and inactive age groups secondary to sympathetic over activity around the immobilized parts. No standard of treatment still exists for treating early stages of AVN, of the cases eventually progressing to a late arthritic stage needing surgical intervention. Bisphosphonates have been shown to prevent disease progression, bone collapse, and the requirement for surgery in avascular necrosis of bone following immobilization of fracture commonly around wrist and hand. The present study is conducted to evaluate the response of bisphosphonates in the l management of the early stages of AVN following fracture disease which usually is untreated where pt presents with stiffness and swelling around the hand and finger and foot. Materials and methods: Prospectively collected data of 80 patients diagnosed with an fracture disease and treated with the combination of intravenous zolendronic acid (ZA) with calcium supplementation for 2-3 consecutive years year, between Jan 2016 to Dec 2018, was evaluated retrospectively. Clinical evaluation was done using the visual analogue scale (VAS), mean analgesic requirement, and range of motion. Radiographs were taken to monitor radiological collapse, and evaluate radiological progression and bone marrow and cortical changes at regular intervals of 6 moths each, changes were categorized based on clinical evolution of progress in osteosynthesis based on regular wt bearing and active mobilization of the affected part. Results: In our analysis of 80 patients (9 lost to follow-up), 55 patients had fracture disease around the wrist and 53 patients were treated by osteopaths and 2 by casts, and 25 patients had fracture disease around the foot and metatarsal head were treated by osteopaths. Pain relief with the drop in VAS score was seen at a mean duration of 6-8 weeks (range 5–15 weeks) after the start of therapy. ZOLendronate ..............

ABSTRACT
Background: Cervical spinal cord injury (SCI) accounts for 2–3% of all trauma patients. Injury to the spine and spinal cord is one of the common cause of disability and death. Several factors affect the outcome; but which are these factors (alone and in combination), are determining the outcomes are still unknown. The aim of the study was to evaluate the factors influencing the outcome following acute cervical spine injury. Materials and Methods: A prospective observational, single‑center, the nonrandomized study of all patients with cervical spinal injury attending Emergency Department within a week of injury, who were surgically managed in the Department of orthopedics, Mymensingh Medical College Hospital, Mymensingh, Bangladesh were included in the study. Demographic factors such as age, gender, etiology of injury, preoperative American Spinal Injury Association (ASIA) grade, upper (C2‑C4) versus lower (C5‑C7) cervical level of injury, image logical factors on magnetic resonance imaging (MRI), and timing of intervention were studied. Change in neurological status by one or more ASIA grade from the date of admission to 6 months follow‑up was taken as an improvement. Functional grading was assessed using the functional independence measure (FIM) scale at 6 months follow‑up. Results: A total of 39 patients with an acute cervical spine injury, managed surgically were included in this study. Follow‑up was available for 38 patients at 6 months. No improvement was noted in patients with ASIA Grade A. Maximum improvement was noted in ASIA Grade D group (83.3%). The improvement was more significant in lower cervical region injuries. Patient with cord contusion showed no improvement as opposed to those with just edema wherein; the improvement was seen in 62.5% patients. Percentage of improvement in cord edema ≤3 segments (75%) was significantly higher than edema with >3 segments (42.9%). Maximum improvement in FIM score was noted in ASIA Grade C and patients who had edema

ABSTRACT
Of all the misalignments of the first ray of the foot, the dorsal bunion is the least known. The dorsal bunion deformity consists of the elevation of first metatarsal head, plantar flexion contracture at the first metatarsophalangeal joint, and dorsiflexion contracture of the tars-metatarsal joint. The deformity presents most commonly after clubfoot treatment but can also be a sequela of various neuromuscular foot conditions, including poliomyelitis and cerebral palsy. We report two case of dorsal bunion. A 30 year-old man and a 14 year-old girl, the both are an iatrogenic pathology secondary to a clubfoot surgery. Treated by different surgery technique and the results were satisfied in the two cases. The dorsal bunion results from a musculo-ligament imbalance at the level of the first ray, which involves 4 muscles: the long fibular, the flexor of the hallux, the anterior tibial and the triceps sural. The flexibility of the navicular-cuneate and cuneo-metatarsal joints also plays an important role. It was Lapidus who coined the term "dorsal bunion" and developed an operative technique that bears his name. Several interventions have been proposed in the literature, the majority of which stem from Lapidus's intervention.

ABSTRACT
It has been suggested that an increased tibial slope and a narrow inter-condylar notch increase the risk of anterior cruciate ligament (ACL) injury. The aim of this study was to establish why there are conflicting reports on their significance. It was a retrospective and comparative case-control study out of 80 patients divided into two groups. Group 1 consisted of 40 patients with unilateral ACL rupture. Group 2 involved 40 control subjects. We measured the Tibial Slope on lateral knee X-ray by three methods. The geometry of the Inter-condylar Notch was evaluated by the notch width index, the notch shape index and the notch height index on Schuss radiography and on MRI. The Group 1 average Tibial Slope was above the Group 2 average regardless of the method of measurement, with a statistical difference significant (P< 0.05). Mean notch width index and mean notch shape index in-group 1 were lower than those in Group 2, with a statistically significant difference (P < 0.05). Ninety-five percent of our Group 1 had at least one of these two factors. Our study showed that a high Tibial Slope and narrow inter-condylar notch geometry were risk factors for ACL rupture. Sports medicine must screen for those factors, especially in pivot sports. The surgeon should take consideration of these factors both in the surgical technique and in the post-operative follow-up.

ABSTRACT
Acute dislocation of the patella occurs commonly to the lateral side. Intra-articular dislocation with rotation of the patella around its horizontal or vertical axis, althought rare can occur. In this type of injury, the displaced patella becomes locked within the joint and rarely can be reduced by manipulation. The following report describes an additional case of this lesion, which was associated to an avulsion of the quadriceps tendon.

ABSTRACT
Background: To evaluate bone metabolism in patients with ankylosing spondylitis (AS) and test the hypothesis that nitrite, fetuin A with vitamin D and TNF-α serum concentrations are correlated with the severity of bone loss as assessed by bone mineral density (BMD) and biochemical markers of bone turnover. Osteoporosis occurs frequently in patients with AS and OPG represents a soluble decoy receptor that neutralizes receptor activator of nuclear factor-κB ligand (RANKL), an essential cytokine for osteoclast function. Materials and Methods: In our study, patients with ankylosing spondylitis (AS) who were visiting or admitted in the OPD and Emergency departments of Mahavir Institute of Medical Sciences, Vikarabad were formally enrolled for this study. Clinical data, radiographs of the spine, BMD of lumbar spine and the femur, biochemical markers of bone turnover, and serum levels of feutin A, nitrite were evaluated in 60 patients with AS (72% men) and 60 age-matched healthy controls (76% men). The estimation and comparison in serum biomarkers' levels have been analysed in concern with their ability to predict impaired healing at an early stage. All this consolidated data was analysed using SPSS software. Results: The result showed significant variations in measuring haemoglobin (Hb), Serum nitrite but significant increase of white blood cells (WBCs), platelets count and erythrocyte sedimentation rate (ESR) with increasing of TNF-α (P value<0.01) among different group. Conclusions: From the result can be accomplish that fetuin A with vitamin D and TNF-α play essential role in prognosis and aetiology of AS. Thus, measurements of these biomarkershold promise in differentiating between inflammatory and mechanical low back pain.

ABSTRACT
We report a rare case of myositis ossificans of the foot. Myositis ossificans is a benign, tumor-like lesion characterized by heterotopic ossification of the soft tissues that usually affects the elbow and thigh. The presence of myositis ossificans in the foot is rare and only a few cases have been reported in the literature. At different stages of maturity, it has similar histological features with sarcomatous lesions. Misdiagnosis can lead to unnecessary radical treatment. The important clinical teaching of our case is that myositis ossificans can take various aspects. The knowledge of unusual sites of myositis ossificans is necessary to differentiate this lesion from malignant soft tissue tumors. This will avoid diagnostic pitfalls and unnecessary investigations, which can have complications for patients.