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

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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 ..........

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This article focuses on pleomorphic sarcomas, which are malignant mesenchymal tumors with a complex genetic background underlying their morphological pleomorphism. These are poorly differentiated tumors that can maintain different lines of differentiation, sometimes correlating with clinicopathological or prognostic characteristics. Accurate diagnosis in this group of tumors relies on adequate sampling due to their heterogeneity and evaluation by both microscopy and large immunohistochemistry panels. Molecular analyzes have a limited role in their diagnosis as opposed to translocation-related sarcomas, but they may provide important the anotic and prognostic information in the future.

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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.

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Introduction: Pancoast-Tobias tumor (PTT), is a rare presentation of lung cancer that affects less than 5% of patients. Vertebral hemangioma is a benign tumor that develops in the endothelial lining of blood vessels. It is rarely symptomatic in adults, with only 0.9 to 1.2% of all vertebral hemangiomas being symptomatic. Materials and Methods: A 69 years old patient presented with right-sided chest pain, cough but no dyspnea associated with a weight loss of 10 kg over the past 06months. The patient reported inflammatory back pain that had been evolving for 2 years and had worsened in recent months. Chest X-ray-CT scan and MRI revealed a tumor mass in the apical segment of the right upper lobe extending into the right posterior mediastinal space at the costo-vertebral groove, measuring 38*33 mm with D2 and D3 vertebral body nodule in T1 isosignal, T2 hypersignal enhancing after gadolinium injection, consistent with an aggressive vertebral angioma (AVA). A multidisciplinary approach was organized, and the indication was to perform preoperative embolization, followed by hemivertebrectomy of D12 associated with costolobectomy. The patient refused to continue the treatment and passed away after 05 months. Discussion: Most vertebral angiomas are discovered incidentally and should not be treated. Pain is generally the most common symptom of discovery. MRI remains the most effective in exploring vertebral angiomas. PTT can extend to the cervicothoracic outlet, the diagnosis of these tumors calls for chest X-ray. Thoraco-abdomino-pelvic CT scan is part of the extension assessment and MRI allows for precise analysis. The management of the exclusive association of PTT and AVA remains a a challenge. Conclusion: The combination of PTT and a set of AVA is extremely rare and doesn’t appear to be described in the literature. The central problem remains the management, which is a challenge for the responsible surgical team.

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Background: Congenital clubfoot is one of the common congenital disorders. Surgery plays an important role in the treatment of patients with this deformity. Comparative studies after surgical treatment might be beneficial. Hypothesis: Surgical treatment of congenital idiopathic club foot by McKay procedure gives better results than Turco procedure. Objectives: To compare the outcome of surgical treatment of congenital idiopathic club foot between McKay procedure and Turco procedure. Methods: This is a prospective interventional study carried out at Orthopaedic Department of Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, during the period of January 2007 to December 2008. 25 patients with 36 feet were selected in which Group-I consisted of 13 patients with 19 feet treated with surgery by Mckay's procedure and Group- II consisted of 12 patients with 17 feet treated with surgery by Turco's procedure. All the ethical considerations were fulfilled. A questionnaire was designed and prepared by the researcher himself. Diagnosis was confirmed by detailed medical history, clinical examinations and relevant investigations. Then through Turco or cincinnati incision surgery was done in two groups. Statistical analysis were done by SPSS (Statistical Package for the Social Science). Results: There were satisfactory results (Excellent + Good) in 17 feet (89.47%) and unsatisfactory results (fair + poor) were in 2 feet (10.53%) in Mckay's procedure. Where as satisfactory results (Excellent + Good) were in 9 feet (52.94%) and unsatisfactory results (fair + poor) were in 8 feet (47.06%) in Turco's procedure. Conclusion: Operative treatment of congenital clubfoot deformity is always an accepted method of treatment. The final outcome of the results shows that in Mckay's procedure satisfactory results was found in 89.47% which is more than Turco's procedure 52.94%.

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Introduction: Temporomandibular disorders (TMD) related headaches is very common in the global population these days.77% of patients with TMD often complains of headache and orofacial pain. The Cartilage surrounding the joint is also affected and also the surrounding structures, clinically showing pain, stiffness, tenderness, trigger points due to bruxism, over loading due to one sided chewing, genetic factors that leads to flattening of the concavity, osteophytes and erosion of the joint margins. Aim and Objective: The aim of the study is to see the effectiveness of dry needling technique on orofacial muscles and suboccipital muscles in TMD related headache. Method: 30 patients with TMD related headache who visited the physiotherapy department and dental OPD were included in the study with patient consent. Patients were divided randomly into two groups; Group A received dry needling technique with occlusal splint at night, and Group B received medication with occlusal splint. Pain was evaluated by Visual Analogue Scale (VAS), active myofascial trigger point (AMTrP) was assessed by palpating tenderness and Functional Disability evaluation was done by Headache Index (HI). Pre-and post-intervention in both groups. Independent t-tests were used to compare the pre-and post-intervention results in both groups. Results: Experimental group who were treated with dry needling exhibited significant improvement as compared to the control group. Conclusion: Dry needling is an effective technique for reducing headache in TMD without any adverse reaction. we commend it to be a good technique for such patients.