ABSTRACT
Intramedullary nailing has increasingly become the standard surgical technique for treating diaphyseal fractures of long bones. Experimental and clinical studies have shown that reaming stimulates bone healing and promotes earlier fracture consolidation without significantly increasing the risk of local or systemic complications. However, its negative impact on endosteal blood flow is well-documented. Minimally reamed nailing offers a promising alternative, preserving the osteogenic benefits of reaming while minimizing its harmful effects on endosteal circulation. This study presents a series of 140 cases of patients with diaphyseal fractures of the lower limbs, all treated with minimally reamed intramedullary nailing.

ABSTRACT
This retrospective study concerns 40 cases of neglected rupture of the Achilles tendon listed in the Traumatology-Orthopedics department of the Avicenne Military Hospital in Marrakech over a period of 7 years, between 2017 and 2022. Our patients are 34 men and 6 women, the average age was 37 years (between 27 and 59 years). The average consultation time was 8 weeks. The causes of the delay in diagnosis are, on the one hand, the negligence of the patients (85%) and, on the other hand, the error of initial diagnosis and the traditional practice. The clinical examination was sufficient to make the diagnosis, although all patients received standard x-ray and ultrasound to eliminate other differential diagnosis. The treatment was surgical in all cases. Three surgical techniques were performed; V-Y plasty as described by Abraham, Bosworth plasty and the transfer with tendon of the flexor hallucis longus muscle. The long-term results were evaluated according to the score of AOFAS (American Orthopaedic Foot & Ankle Society) with a follow-up between a minimum of 2 years and a maximum of 7 years. The aim of our work is to describe the epidemiological, clinical and diagnostic profiles of patients and to evaluate the value of surgery in neglected ruptures of the Achilles tendon, by studying the indications of the different surgical techniques used.

ABSTRACT
Dorsal dislocations of the metacarpophalangeal joint of the thumb are rare. Complex dorsal dislocations are defined by the entrapment of the sesamoid bones and the soft tissue, such as the volar plate, behind the phalanx at the level of the metacarpal neck. These cases often necessitate open reduction. We present the case of a 22-year-old male patient who was admitted to our institution with a dorsal metacarpophalangeal dislocation of the thumb. Surgical reduction was required following the failure of closed reduction attempts.

ABSTRACT
Background: Failed Back Surgery Syndrome poses a significant challenge due to persistent pain following spinal surgery, greatly affecting patient quality of life and healthcare resources. Objective: This study aims to evaluate the effectiveness of revision spine surgery in FBSS patients, identifying key predictors for improved clinical outcomes. Method: A prospective study was conducted at a tertiary-level hospital in Bangladesh, involving 98 FBSS patients undergoing revision spine surgery from June 2020 to June 2023. Outcome measures included pain reduction (Visual Analog Scale), functional improvement (Oswestry Disability Index), and patient-reported quality of life. Result: Six months post-surgery, 74% of patients experienced clinically significant pain reduction (>50% on VAS), while 63% showed notable functional improvement with a reduction in ODI scores of over 40%. Quality of life improved for 68% of patients, with 25% reporting a complete return to daily activities. Among surgical types, decompression led to a 58% improvement in mobility, while fusion procedures resulted in a 70% pain reduction. However, 12% of patients reported little to no improvement, and 5% experienced worsened symptoms, underscoring the variability in outcomes. Predictive success factors included shorter intervals between surgeries and lower initial pain levels (p < 0.05). Overall, revision surgery was beneficial for the majority, but not all patients achieved desired outcomes. Conclusion: Revision spine surgery in FBSS patients can lead to significant improvements, though outcomes vary. Identifying predictive factors is essential to guide surgical planning and enhance patient selection.

ABSTRACT
Joint fractures of the base of the fifth metacarpal are rare injuries but they can cause serious complications if poorly managed, such as weak grip strength and wrist extension, decreased range of motion, osteoarthritis, tendon rupture, and carpal instability. We focus on two entities, Bennett and Rolando fractures regarding their mechanisms and tendency to instability. Their treatment remains a controversial subject. Through a series of 13 joint fractures of the base of the fifth metacarpal collected between December 2022 and June 2023 treated in the Orthopedic Department of Ibn Sina Hospital in Rabat, and a review of the literature, we review the data on anatomy, biomechanics, pathophysiology, diagnostic and therapeutic means and the prognosis of Bennett fractures by showing the benefit of osteosynthesis by Iselin double intermetacarpal pinning

ABSTRACT
Background: Delayed union fractures pose a significant clinical challenge, often requiring enhanced treatment modalities to accelerate healing and improve patient outcomes. Various techniques, including autologous bone grafting and biologic agents like platelet-rich plasma (PRP) and bone morphogenetic proteins (BMPs), have been employed to stimulate bone regeneration. However, the optimal approach remains debated. Objective: This study aimed to compare the efficacy of autologous bone grafting, biologic agents, and combined therapies in promoting fracture healing, reducing pain, improving functional outcomes, and enhancing patient satisfaction in delayed union fractures. Methods: A prospective study was conducted on 80 patients with delayed union fractures. Patients were randomly assigned to one of four groups: standard care (control), autologous bone grafting, biologic agents (PRP and BMPs), or a combination of bone grafting and biologic agents. Radiographic healing was assessed at 6, 12, and 24 weeks. Pain intensity was measured using the Visual Analog Scale (VAS), functional outcomes were assessed using the AAOS lower limb function scale, and patient satisfaction was evaluated using a Likert scale. Results: The combined therapy group exhibited significantly faster radiographic healing, with 80% of patients showing callus formation at 6 weeks and 95% achieving complete union at 24 weeks, compared to 35% in the control group. The combined group also reported the greatest reduction in VAS pain scores, with a mean decrease from 7.8 to 1.5 at 24 weeks (p<0.001). Functional outcomes were significantly improved in the combined group, with a mean AAOS score of 100 at 24 weeks, compared to 70 in the control group (p<0.001). Additionally, 90% of patients in the combined group reported high satisfaction, compared to 40% in the control group. Conclusion: The combination of autologous bone grafting and biologic agents, such as PRP and BMPs, significantly accelerates ..........

ABSTRACT
Isolated acute dislocation of the distal radioulnar joint is a rare lesion, and in 50 % of cases goes unrecognized; it may be palmar or dorsal. Its diagnosis is suspected when the wrist is traumatic, painful, with limited pronosupination and no fracture on radiological examination. Treatment is aimed at preventing the development of chronic instability and/or arthrosis, and consists of reduction followed by immobilization.