ABSTRACT
Background: Traditional bone setters (TBS) remain integral to fracture care in Nigeria, often serving as the first point of contact for injured patients. Understanding the healthcare journey from traditional to modern medicine is crucial for improving orthopedic outcomes and reducing complications in resource-limited settings. Objective: To analyze healthcare-seeking patterns, treatment delays, complications, and outcomes among fracture patients who visited traditional bone setters before presenting to a Nigerian secondary healthcare center. Methods: A retrospective cross-sectional study was conducted at Ring Road State Hospital, Ibadan, over 36 months from June 2022 to June 2025. Data from 62 consecutive orthopaedic patients were analyzed, comparing outcomes between TBS users and non-users. Clinical monitoring included complications, amputation rates, and final outcomes using standardized assessment protocols. Statistical analysis was performed using SPSS version 21. Results: Overall, 45.2% (28/62) of patients visited TBS before hospital presentation. TBS users had significantly higher complication rates (25.0% vs 8.8%, p<0.05, RR=2.8, 95%CI: 1.2-6.7), amputation rates (21.4% vs 5.9%, p<0.05, RR=3.6, 95%CI: 1.2-11.0), and longer delays to definitive care (median 3 weeks vs 3 days). Chronic osteomyelitis was 3.6 times more common in TBS users (21.4% vs 5.9%). Case neglect occurred in 35.5% of patients, with 77% being TBS users. Conclusion: Traditional bone setter utilization significantly increases the risk of complications, amputations, and treatment delays in fracture patients. The study demonstrates urgent need for integrated healthcare models and community education to bridge the gap between traditional and modern orthopedic care in Nigeria.

ABSTRACT
Background: Operating theatre efficiency and utilization patterns in secondary healthcare centers across sub-Saharan Africa remain poorly documented despite their critical role in surgical care delivery. Understanding these patterns is essential for optimizing resource allocation and improving surgical outcomes in resource-limited settings. Objective: To analyze operating theatre utilization patterns, case complexity, resource optimization strategies, and perioperative outcomes in orthopedic surgery at a Nigerian secondary healthcare center, comparing findings with international benchmarks. Methods: A retrospective audit of 62 consecutive orthopedic surgical cases at Adeoyo State Hospital was performed conducted over 36 months from June 2022 to June 2025. Data analyzed included surgical procedures, case complexity, duration, blood loss, transfusion requirements, and perioperative outcomes. Theatre efficiency metrics were calculated, and statistical analysis using SPSS version 21. Results: ORIF procedures dominated (29.0%), followed by hemiarthroplasty (22.6%) and amputations (12.9%). Mean case duration was 3.2±1.4 hours with 51.6% classified as moderate complexity. Blood transfusion was required in 41.9% of cases (mean 1.2±0.4 units). Theatre utilization averaged 65.4% with 70% emergency procedures. Overall complication rate was 6.5% with no perioperative mortality. Mean length of stay was 12.8±6.7 days. Conclusion: Secondary care orthopedic theatres demonstrate efficient utilization despite resource constraints, successfully handling complex cases with acceptable outcomes. However, high transfusion rates and extended hospital stays suggest opportunities for optimization through enhanced perioperative protocols and improved resource planning.

ABSTRACT
Background: Laminectomy and discectomy are established surgical treatments for Prolapsed intervertebral disc (PIVD), aiming to decompress neural structures. However, routine addition of pedicle screw fixation in the absence of overt spinal instability remains a subject of ongoing debate. This study aimed to evaluate and compare functional outcomes in patients presenting with PIVD treated by laminectomy and discectomy without or with concomitant pedicle screw fixation. Materials and Methods: This comparative study was conducted in the Department of Orthopaedics, for a period of 18 months, which included 96 patients divided into two treatment groups of laminectomy and discectomy: (a) Without pedicle screw fixation, and (b) With pedicle screw fixation. Patients were followed up at 1, 3, and 6 months for post-operative functional outcome of patients, as assessed by the VAS scores for low back pain and leg pain, Oswestry Low Back Pain Disability Questionnaire, JOA scores, Roland-Morris Low Back Pain and Disability Questionnaire, and muscle power grading. Results: There was statistically significant improvement in the NPRS scores from baseline to 6-month follow-up period in both the study groups (p<0.001). Additionally, there was improvement in other outcome parameters in both study groups from pre-operative to 6-month follow-up, but the difference was not statistically significant (p>0.05). Conclusion: The study concluded that routine application of pedicle screw fixation may not be essential for this specific patient demographic, potentially enabling a less invasive surgical approach.

ABSTRACT
Comminuted fractures of the distal femur are a therapeutic challenge due to their anatomical complexity and frequent association with bone fragility, especially in elderly patients. The introduction of locked condylar plates has brought significant progress in the surgical management of these lesions. These plates offer superior angular stability, particularly useful in the presence of multiple fragments or osteoporosis. This retrospective study was conducted at the Ibn Sina University Hospital in Rabat, including 32 patients operated for comminuted distal femur fractures (AO/OTA types C2 and C3) between January 2018 and December 2023. All cases were treated using locked condylar plates, with early rehabilitation and a minimum follow-up of 12 months. Bone union was achieved on average at 14.6 weeks. The mean functional outcome (Knee Society Score) at 12 months was 82.7. Complications were rare: two cases of stiffness requiring arthrolysis, one case of superficial infection managed medically, and no cases of nonunion. These results confirm the efficacy and reliability of locked condylar plates in stabilizing complex comminuted fractures of the distal femur.

ABSTRACT
Scaphoid fractures are difficult to diagnose and treat. The authors report the results of treating these fractures with percutaneous screw fixation using the Herbert screw. The results were interesting given the rapid consolidation and the quality of the functional outcome.

ABSTRACT
Fractures of the upper end of the humerus pose a therapeutic problem, particularly for complex fractures with 3 and 4 fragments. The objective of this study is to determine the epidemiological-clinical characteristics of complex fractures of the upper end of the humerus in adults and to assess the functional and radiological outcomes of our series. This series consists of 15 cases collected at the orthopedics department of CHU Ibn Sina between 2021 and 2015. We recorded the epidemiological data of the patients and the circumstances of the trauma. The treatment was primarily surgical, either plate synthesis or nail fixation. The reduction was evaluated based on postoperative X-rays. At follow-up, functional results were assessed using the Constant score. Our series includes 8 men and 7 women, with an average age of 57 years; traffic accidents were noted in 48% of cases, and 4-fragment fractures were found in 76%.des cas. Plate osteosynthesis was used in 40% of cases and anterograde nailing was performed in 40% of cases. The average Constant score was 65.24 with extremes ranging from 35 to 88. We noted consolidation of fractures without malunion in 68%. In complex fractures of the proximal humerus, appropriately indicated osteosynthesis based on the patient and the fracture, along with early postoperative rehabilitation, results in acceptable functional outcomes.

ABSTRACT
The femoral offset is the most important prognostic element in hip arthroplasty. Its restoration is crucial. Any change in the native value of the offset affects the quality of clinical function of the hip. The aim of our study was to evaluate the clinical function of the hip based on the value of the femoral offset after arthroplasty. This is a retrospective study conducted between 2010 and 2013, involving 27 patients who underwent total hip arthroplasty. Patients who had previous surgical procedures on the same hip or on the contralateral hip were excluded. Measurements were taken from standard hip radiographs in approximately 15° internal rotation, with magnification at 100%. Clinical results were assessed using the WOMAC score, which averaged 15.2 points, and the Merle d'Aubigné-Postel score, with an average of 15 points. Two other tests were also evaluated in our study, the step and hop tests were used. The best functional results were obtained in patients who had a lateralization of the femoral stem with an increased offset.