ABSTRACT
Introduction: Open fractures of the limbs are a formidable surgical emergency because of the osteo-muscular damage and the high risk of infection. External fixation is a method of choice, allowing the fracture site to be stabilised at a distance. This work analyses the anatomical, functional and medico-legal results of management with external fixators in the Department of Orthopaedics and Traumatology of the Ignace Deen National Hospital in Conakry. Patients and Methods: This was a 12-month prospective study (1 January – 31 December 2019) that included 27 cases of open fractures of the limbs treated by external fixator among 34 cases collected (out of 297 hospitalisations). Epidemiological, clinical, therapeutic and outcome data were collected. Skin opening was classified according to Cauchoix and Duparc, and results were assessed using the Johner and Wruhs criteria. Results: The mean age was 36.5 years (range: 13–60 years), with a male predominance (sex ratio = 2.8). Road traffic accidents (RTAs) accounted for 66.67% of aetiologies. The leg was the most frequent site (81.48%). The Hoffmann fixator was used in 77.78% of cases. Ten cases of infection were recorded, including 5 sequestrating osteitis. The mean length of hospital stay was 106 days. At final evaluation (12 patients in dynamic follow-up), results were excellent in 58.34%, good in 25%, fair in 8.33% and poor in 8.33%. Conclusion: External fixation remains an effective method for the management of open fractures of the limbs in African conditions, giving good anatomical and functional results despite prolonged delays before care. The medico-legal impact, particularly in the context of RTAs, calls for rigorous documentation and systematic expertise.

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Introduction: Tibial plateau fractures (TPFs) are severe articular fractures of the proximal tibia that threaten knee stability and mobility. Their increasing incidence, associated with the rise in road traffic, and their functional impact justify rigorous management and particular attention to their medico-legal implications. Materials and Methods: This was a 12-month prospective descriptive study conducted from March 17, 2014, to March 16, 2015, including 18 cases of TPFs treated in the Department of Orthopaedics and Traumatology at Ignace Deen University Hospital, out of 4,215 hospital admissions. Epidemiological, clinical, therapeutic, and outcome data were collected. The Duparc and Ficat classification was used, and outcomes were assessed according to the Merle d’Aubigné and Mazas functional criteria. Results: The frequency of TPFs was 0.42% of hospital admissions. The mean age was 35.5 years (range: 11–60 years), with a male predominance (sex ratio = 5). Road traffic accidents accounted for 66.66% of cases. Unicondylar fractures were the most frequent, accounting for 72.22% of cases. Surgical treatment was performed in 72.22% of patients. Functional outcomes were very good in 66.67% of cases and good in 27.78%. Six postoperative complications were observed, representing 33.33% of surgically treated patients. The mean length of hospital stay was one to two weeks in 72.22% of cases. Conclusion: TPFs are serious articular injuries for which early surgical management can achieve good functional outcomes. When these fractures occur following road traffic accidents or occupational accidents, they require a structured medico-legal approach, including a comprehensive initial medical certificate, assessment of temporary total incapacity for work (TTIW) and permanent partial impairment (PPI), and thorough documentation of complications.

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Background: Total knee arthroplasty (TKA) is an established treatment for advanced knee disease, but functional recovery varies among patients. Identifying factors associated with postoperative function may help improve patient assessment and rehabilitation planning. Methods: This hospital-based observational study included 90 patients who underwent TKA from July 2024 to June 2026 at the Department of Orthopaedic Surgery, Uttara Adhunik Medical College, Dhaka, Bangladesh and selected private clinics within and outside Dhaka. Demographic and clinical characteristics, including age, sex, BMI, comorbidities, preoperative range of motion (ROM), deformity and functional status, were recorded. Postoperative functional outcome, pain improvement, ROM and walking ability were assessed. Data were analyzed using SPSS version 25, with p<0.05 considered statistically significant. Results: Good functional outcome was observed in 48 (53.3%) patients, moderate in 29 (32.2%) and poor in 13 (14.4%). Satisfactory pain improvement occurred in 67 (74.4%), while 43 (47.8%) achieved postoperative ROM >110°. Age was significantly associated with outcome (p=0.041), with good outcome in 66.7% of patients aged <60 years versus 44.4% aged ≥60 years. BMI (p=0.047), preoperative ROM (p=0.031) and comorbidity (p=0.006) were also significantly associated with functional outcome. Sex was not significantly associated (p=0.248). Conclusion: Functional recovery after TKA was generally favorable. Younger age, lower BMI, better preoperative ROM and absence of comorbidity were associated with better functional outcomes.

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Background: Intertrochanteric fractures of the femur are common hip fractures, particularly among elderly patients with osteoporotic bones, and are associated with substantial morbidity and mortality due to prolonged immobilization and related complications. Therefore, this study aimed to compare the functional outcomes of intertrochanteric fractures treated with proximal femoral nail antirotation (PFNA) and dynamic hip screw (DHS). Methods: This comparative observational study was conducted at the Department of Orthopaedic Surgery, Uttara Adhunik Medical College, Dhaka, Bangladesh, and selected private clinics within and outside Dhaka, from July 2024 to June 2026. Forty patients were included, with 20 treated by PFNA and 20 by DHS. Functional outcomes were assessed using HHS preoperatively and at 3 and 6 months, along with operative parameters and postoperative complications. Statistical significance was set at p<0.05. Results: Among 40 patients, PFNA showed shorter operative time (78.5 vs. 92.3 min; p=0.003), lower blood loss (105.0 vs. 148.5 mL; p<0.001), and higher HHS at 3 and 6 months (78.4 vs. 72.6, p=0.04; 86.7 vs. 81.9, p=0.03) than DHS. Excellent/good outcomes were 85.0% vs. 70.0% (p=0.45), while complications were 15.0% vs. 30.0% (p=0.45), respectively. Conclusion: PFNA provided satisfactory functional outcomes with shorter operative time, lower blood loss, and higher follow-up Harris Hip Scores compared with DHS.

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Background: Artificial intelligence (AI) is increasingly being integrated into total hip arthroplasty (THA), particularly in preoperative planning, predictive modeling, and postoperative imaging analysis. However, current evidence remains heterogeneous regarding methodology, validation, and clinical applicability. Purpose: To systematically review the current applications, clinical utility, limitations, and future perspectives of AI in THA. Methods: A systematic review was conducted according to PRISMA 2020 guidelines. PubMed/MEDLINE, Scopus, and Web of Science were searched for studies published between January 2015 and May 2026. Original studies evaluating AI-based applications in THA were included. Results: Thirteen studies were included in the qualitative synthesis. The principal AI application domains identified were: (1) preoperative planning and implant templating, (2) prediction of complications and functional outcomes, and (3) implant identification and postoperative imaging analysis. AI-assisted three-dimensional planning systems consistently demonstrated improved implant sizing accuracy and planning reproducibility compared with conventional templating techniques. Machine learning algorithms showed promising performance for prediction of postoperative complications, patient-reported outcomes, and periprosthetic joint infection. Deep learning-based imaging systems also demonstrated high accuracy for automated implant recognition using radiographic imaging. Conclusion: Current evidence suggests that AI-assisted technologies may improve planning accuracy, perioperative risk stratification, and workflow optimization in THA. Nevertheless, the available literature remains predominantly retrospective and heterogeneous, with limited external validation and insufficient prospective clinical evaluation.

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Background: The anatomical and biomechanical factors render shoulder joint the most unstable and frequently dislocated joint. Anterior instability is common and glenoidal bony defect result in recurrence. Effective surgical treatment is crucial to restore the normal functioning shoulder and return to the preinjury state The aims of this study were to assess the functional outcome of recurrent anterior shoulder instability with Hill-Sachs lesion following Latarjet procedure by ROWE score and report complications if any. Method: This prospective observational study included 30 patients diagnosed with recurrent anterior shoulder instability following sports injury from January 2025 to December 2025 in NITOR. Convenient sampling technique was applied and patients underwent open Latarjet procedure and followed up at 3rd week, at 6th week, at 3rd month and 6 monthly intervals for 1 year. In each postoperative follow-up, ROWE score of the operated shoulder was done and complications were noted. Results: The median age of the patients was 23.7 years; 63% were between 18-23 years age group. 26(87%) were male and 4(13%) females. Majority of the patients were students. High intensity contact sports, football and kabaddi, resulted in 60% cases of instability. 24(80%) had right shoulder involvement. The median number of dislocations before surgery was approximately 7 and interval between 1st episode and surgery was approximately 18 months. Range of motion and ROWE score had significant improvement (p< 0.001) after surgery and 77% did not present with any complications till last follow-up. Conclusion: Recurrent anterior shoulder instability with Hill-Sachs lesion is common in young individuals involved in contact sports. Surgical treatment with open Latarjet procedure improved range of motion and functional status of the patients with minimal complications.

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Objective: To analyse the epidemiological, clinical, and injury patterns associated with motorcycle-related trauma. Patients and Methods: This was a retrospective descriptive study conducted over a two-year period, from May 2023 to May 2025. Results: During the study period, 2,818 motorcycle accident cases were recorded out of 3,723 road traffic accidents, representing a frequency of 76%. The victims were predominantly male (76%), with a mean age of 29 ± 17 years. Drivers were the most affected occupational group (34%), and motorcycle–car collisions were the leading mechanism of injury (47%). Limb injuries were the most frequent lesions (45%), followed by traumatic brain injuries (24%), predominantly mild forms (63%). Facial bone fractures, thoracic contusions, and open fractures of the lower limb were the most common injuries within their respective categories. The outcome was favourable in 94% of cases, while the mortality rate was 6%. Conclusion: Motorcycle accidents represent a major public health problem, particularly affecting young people. Strengthening prevention strategies and improving trauma management are essential to reduce morbidity and mortality.