Rotator cuff repair techniques are fast evolving. A double row repair gives a promising results. Threads from first row is accomodated into second row devices. We describe a simple suture snare technique to maximize the number of threads that can be passed into second row devices. This enables a stronger and cost effective fixation.

Introduction-The scaphoid bone is the most commonly fractured carpal bone, accounting for 50% to 80% of all carpal bone fractures and approximately 11% of all hand fractures. Mainly young, active individu- als sustain scaphoid fractures.Herbert and Fisher classifi- cation has been used most frequently.Material and method-Materials and Methods-study was carried out between Jan 2020 to Feb 2022, the authors treated 10 scaphoid fractures using the percutaneous scaphoid fixaation technique. There were 8 men and 2 women with a mean age of 25 years.There were 7 fractures on the right side and 3 on the left side. Mechanisms of trauma were fall on out- stretched hands for 9 patients and road traffic accident for 1 patient. 7 fractures were on the dominant side and 3 were on the nondominant side. Mean time from injury to surgery was 2 weeks.Plain radiographs re- vealed the fractures in all cases. All patients had a preoperative plete fracture configuration. A computed tomography scan is strongly recommended if a per- cutaneous procedure is planned. Intraoperative Technique-The patient was placed supine with the affected up- per limb abducted 90°. Hyperextension and ulnar deviation of the wrist accompanied by thumb traction facilitated any necessary reduction of the fracture. The end of the screw was buried beneath the distal surface of the scaphoid to avoid more damage to the scaphotrapezial joint.A 22-mm screw was sufficient in almost all of the cases, with an 20 and 24 mm screw being used in one patient respectively.

Severe lower limb open fractures have an amputation risk of up to 40%. When amputation is indicated, limb length preservation and creating a sensate, pain-free and robust stump are key goals. The pedicled fillet-of-sole flap is recognised as a good option for reconstructing the weight-bearing surface of the amputation stump. We present the first documented cases of a two-staged approach using the fillet-of-sole flap for through knee amputation stump reconstruction in major trauma patients.
We review the indication, technique, clinical course and outcome of two patients presenting to a UK major trauma centre with catastrophic tibia and fibula open fractures with extensive soft tissue degloving and avulsion. Below knee amputation was not possible and through knee amputation was elected to preserve femoral intramedullary nail fixation in one patient and to maximise rehabilitation in the other patient. Both patients received knee and ankle disarticulation with preservation of the posterior tibial neurovascular bundle at the first stage, when they developed acute deterioration intraoperatively. Elevation of the flap was completed and inset at the second operation. There was no flap loss or local infection. One patient developed a thigh collection at the site of his open fracture wound which was treated with washout.
Major trauma patients may acutely deteriorate intra-operatively, necessitating short and safe amputation procedures, but maximising their future rehabilitation potential should also be considered. Our two-staged approach is a well-tolerated modification of the fillet of sole flap, which facilitates limb length preservation even in the most acutely unstable trauma patients.

Background: Negative pressure wound therapy (NPWT) is an effective adjuvant treatment method to manage wounds and open fractures, though cost and device unavailability prevents widespread use in low-income countries. In Cameroon, we evaluated the feasibility and efficacy of a low-cost ($100) NPWT device, called VATARA (Vacuum-Assisted Therapy Affordable foR All). Methods: We performed a prospective case series including all patients with musculoskeletal injuries managed with VATARA at Baptist Hospital Mutengene, Cameroon from 15 March 2021 to 15 March 2022. Patient demographics, wound characteristics, and photographs of the wounds were collected at intake and at each dressing change (every 3 days). All were treated as inpatients. Results: Thirty-two patients (mean age 37 years, 63% male) received NPWT during the study. Twelve patients had road traffic-related injuries (42%), 6 had gunshot injuries (21%), 7 had other injury mechanisms (25%). Wound characteristics were reported for 16 wounds of which 11 were contaminated/dirty and/or infected on presentation. All patients received antibiotics upon arrival. Average treatment duration was 5.9 days; 19% of patients underwent serial operative debridements. No patients developed systemic infection or sepsis. Outcomes were recorded for 15 patients, of which VATARA was successful in achieving wound closure in 12 wounds, 9 receiving a skin graft. Four patients failed NPWT with 3 requiring amputations and 1 patient dying. Fifteen of 18 (83%) providers reported VATARA was effective in managing patients’ wounds. Conclusion: VATARA is an effective, reliable, and affordable NPWT device for managing open fractures and contaminated and/or complex wounds in a resource-limited setting.

Delayed un treated club feet or unsuccessful treated club feet in childhood varies from slight to severe deformities and cause disability in everyday life also emotional stress, and traditional surgical methods of treatment like just tipple arthrodesis can cause foot shortness and patient discomfort , for this reason in order to have normal foot size ,shape and stable foot , I modified a small simple external hinge fixation system SLDF./ Salamehfix 2 / which consists of just three small arcs which can fit the size of every patient and can fix main foot elements , with performing tipple arthrodesis after two weeks we can perform gradual lengthening and correction of main foot components in different direction using various fixator hinges and rods until the foot achieve normal shape and size then the fixator fixed until consolidation usually 4 months , stable fixation and comfortable system can allow patient for walking with partial wight bearing later on external fixaion removed and a plaster applied on the foot and ankle joint for one month , results ; we have 15 cases of clubfeet treated using this system , 9 had excellent results 4 good , 2 fair as there was some collapse after correction due to patient who interrupted treatment. complications mainly superficial pin infection which treated locally , conclusion ; mini external fixation system can help to achieve excellent results in treatment severe to moderate clubfeet deformities .

Introduction: Scoliosis is a complex multidimensional spinal deformity that affects spinal anatomy, quality of movement, walking, and trunk symmetry. These alterations are especially exaggerated in Indian patients who present at a very late and much more deformed state. Posterior spinal fusion (PSF) is performed to stop curve progression, reduce backache, and restore asymmetric torso. In this study, we aimed to investigate the effects of posterior spinal fusion surgery on Spatio-temporal and lower and upper body kinematics in severe Adolescent Idiopathic Scoliosis (AIS) patients during gait. Methods: This study included 15 patients (mean age 16.3 years) with thoracolumbar/lumbar AIS (cobb angle MT 78.62 ± 8.10, TL/L 60.52 ± 7.42). Spatio-temporal parameters and upper and lower body kinematics were evaluated preoperatively and after 6 months of surgery using instrumented 3D gait analysis (BTS, Italy). Student T-test was applied to find significant differences between pre and post-operative gait parameters. Results: Gait speed, cadence, stride length were improved significantly after 6 months of surgery. Step width, gait profile score (GPS), and gait deviation index (GDI) were not changed significantly postoperatively. No significant changes in the mean angle of knee flex extension, hip Ab-adduction, hip flex-extension, ankle dorsiplanterflexion, spine flex extension were observed postoperatively. Conclusion: Posterior spinal fusion with deformity correction improved gait pattern and gait biomechanics in cases of Adolescent Idiopathic Scoliosis.

Introduction: Reconstruction after distal ulna tumor resection is still an enigma among the orthopaedic oncologists. We present the functional outcomes of ulnar buttress arthroplasty without stabilization of the ulna stump in GCTB of the distal ulna. Methods: Evaluation of functional outcome was performed using MSTS93 score, Modified Mayo Wrist score and DASH questionnaire. We also assessed the hand grip strength, range of motion at the wrist, radio-carpal stability, ulnar carpal translation and radio-ulnar convergence. Results: The study included 8 patients with Campanacci grade 3 GCTB of the distal ulna. The mean resection length was found to be 7.7 +/- 1.3 cm. The mean hand grip strength on the operated side was found to be 90 +/- 0.04% of the contralateral side. The average overall MSTS93 score was 27.9 +/- 1.25, mean Modified Mayo Wrist score (MMWS) was 86.9 +/- 4.58% and the mean DASH score was 4.9 +/- 1.67, depicting a good to excellent functional outcome with low degree of disability. No radio-carpal instability, prominence or radial convergence of the proximal ulnar stump, ulnar impingement, radio-carpal instability or carpal translation was noted in any patient. Conclusion: Reconstruction of the distal radio-ulnar joint for the prevention of ulnar carpal subluxation is paramount to preserve good grip strength. Ulnar buttress arthroplasty using iliac crest bone graft provides good functional outcome and preservation of good hand grip strength. We do not recommend routine stabilization of the stump after resection of the distal ulna.
Level of Evidence: Level IV, Therapeutic study

Background: Chronic osteomyelitis(COM) is a debilitating disease for the patient and the healthcare system; analysing the local situation would provide better plans to tackle it. Methods: Thirty-three patients with osteomyelitis were treated in our centre. All had COM; 16 tibial involvement, ten femurs, four fibulas, two ulnae and one calcaneus.
Seventeen patients(52%) had postoperative COM after managing closed fractures by ORIF; 13(40%) had open fractures, two hematogenous OM, and one primary sclerosing OM. Three to six deep tissue samples (culture/sensitivity) were collected during index debridement and one histopathology sample. At the time of debridement, OM was diffuse in 23(70%), localised in six and intramedullary in four. 16(49%) patients had no implants, the rest had internal/external fixation. Results: The median interval between injury and onset of infection was six weeks(1-179). The interval between the onset of infection and index debridement by the author was ten months (1-135). Patients had a median of 3(0-7) operations before referral.
The median age at operation was 37 years old (7-73). Histopathology confirmed osteomyelitis in all patients. Five patients (15%) had no growth on standard non-extended culture. Five patients (15%) had polymicrobial growth (G+ve and G-ve). 12 patients (36%) had G-ve organisms (Pseudomonas, proteus, E-coli, Klebsiella and others). 11 patients (33%) had G+-ve organisms (MRSA, MSSA, CONS “MRS” and Enterococci). Conclusion:There may be a shift in our region’s aetiologies and causative organisms; closed fractures turn into COM postoperatively, several unsuccessful attempts, delayed index debridement, and more G-ve organisms. Plans need to be applied to improve outcomes.

Introduction: The reconstruction of large acetabular defects in revision hip arthroplasty represents a challenge to the surgeon and increases the complexity of the case. There are different options to overcome the problem of acetabular deficiency. In the elderly low demand patients, the main objective of revision surgery is to provide pain relief, allow immediate full weight bearing, and an early return to function.

Methods: This article presents our experience in acetabular revision surgery using a novel technique of two stage cementation and screw augmentation in low demand patients. We report on the surgical technique and present the early results in 10 patients.

Results: There were 6 females and 4 males with average age of 83.8 years. Patients were followed up for an average of 18.1 months. All patients were pain free and full weight bearing at the time of the final follow up with radiographs showing maintenance of implant position. None of the patients underwent revision surgery and there were no radiographic signs of failure detected in the early follow-up period.

Conclusion: This is a suitable technique in the management of large acetabular defects in revision hip arthroplasty, especially in the low demand patient population. It is a simple cost effective technique that reduces the complexity of the acetabular revision, operative time, and morbidity associated with prolonged complex revision surgery.

Introduction: The heel pad is a dense band of fibrous tissue with complex anatomy. Injuries to heel pad are uncommon but very challenging due to its precarious blood supply. In this study we tried fixing acute injury to heel pad using multiple kirschner wires. Material/Methods: A Retrospective study was conducted over a period of 3 years from 2017 to 2020 in which 12 patients with acute injury of the heel fat pad admitted to our hospital were selected for the study: Out of them 9 patients were included on the basis of inclusion criteria. After initial assessment and stabilisation of patient the heel pad was debrided and fixed using multiple K wires. The clinical results were evaluated according to the American Orthopedic Foot and Ankle Society hind foot score. Results: After fixation of heel pad avulsion using multiple K wire all 9 patients included in our study had a viable heel pad in their follow up. 2 patients developed edge necrosis, none of them developed any infection. Results were excellent for 3 out of 9 patients and good for 6 patients according to the AOFAHS scoring system. Conclusions: Anchorage of acute heel pad avulsion injuries using multiple kirschner wires is an effective and reliable treatment modality, with high success rates and allows complete weight bearing with no or very little pain.

Adults of any age can be considered for a hip replacement, although most are done on people between the ages of 60 and 80. In this study, 50 patients under the age of 50 were included in a retrospective study requiring a total hip prosthesis (THP). In our series, 31.91% were due to aseptic osteonecrosis of the femoral head and 23.4% were due to inflammatory coxitis. The average age was 36 years, lower than the average age reported in literature. This can be explained by the young age of the Moroccan population compared to the western population and by the frequency of pathologies affecting the young subject in our context: coxitis. Inflammatory, post-traumatic osteoarthritis. The results of our study showed a marked improvement in the score of Postel and Merle d’Aubigné after the total hip prosthesis. The results before 50 years are variously evaluated in the literature. It is classic to say that prosthetic longevity is generally lower than that of an older population. Indeed, young patients mechanically use their hips more often.However, functional impairment due to pain, loss of mobility and lameness due to hip osteoarthritis, requires surgical management after initial medical management to delay as far as possible the surgery. Nevertheless, the ceramic / ceramic friction in correct configurations, allows hoping a prolonged implantation and therefore a longterm strategy without consequence on the functional result.