Background: Avascular necrosis (AVN) of the femoral head usually occurs in the active age of life, and is an increasingly common cause of musculoskeletal disability. Objective: we envisage to evaluate and compare the clinic oradiological outcomes between TFL muscle pedicle bone graft and no vascularized fibular grafting after core decompression prior to hip joint involvement of AVN femoral head provides painless and mobile life. Method: January 2013 to December 2019, total 64 hips (44 patients) in the age group of 18-48 years (mean 30.36±4.64 years) were included in this prospective study. Ficat and Arlet staging system was used, Stage I (n=10 hips), Stage II (n=44 hips) and stage III (n=10) of AVN of femoral head, were included after clinical and radiological evaluation, where 32 hips (half of all stage-I, II and III) were treated with fibular graft (Group 1) and rest 32 hips were treated with TFL muscle pedicle bone graft (Group 2) after decompression of femoral head. Preoperative Harris Hip Score (HHS), visual analog score (VAS), plain radiographs, and magnetic resonance imaging (MRI) were compared with serial postoperative HHS, VAS, plain radiographs at regular interval. The average follow up was 56 months. Result: Out of 44 patients, male was 28 (63.64%) and female was 16 (36.36%). Failure of surgery was defined as progression of the disease, which was n=1,10% (1/5, 20% in group 1, 0% in group-2) in stage I, n=12/44, 27.27% (7/22, 31.82% in group-1 and 5/22, 22.73% in group-2) in stage II and n=5/10, 50% (2/5, 40% in group 1 and 3/5, 60% in group 2) in stage III disease. Median values of HHS at the end of the follow up in Group I was 80 and 76 in Group 2, compared to the preoperative HHS of 56 and 52 respectively.. Overall satisfactory result was 71.88%, p value was <0.01, that is significant. In group 1 satisfactory result was 22/32 (68.75%) but 24/32 (75%) in group 2, no statistical significant difference (>0.05) between two groups. Even in early stage III disease, only 50% was effective. Conclusion: Core decompression with bone graft is effective in preserving the sphericity of the femoral head and to delay the progression in the early stages of the AVN of femoral head, (Stage I and II), fibular graft gives early stability but long term results are similar in both group.

The hand grip is severely impaired following high radial nerve palsy due to loss of extension of the wrist, metacarpo- phalangeal joint of fingers and thumb. If radial nerve does not show neural recovery following conservative or surgical repair during the optimum time, tendon transfer is considered the standard treatment. To evaluate and compare the clinical outcome between flexor carpi radialis and flexor carpiulnaris tendon transfer for fingers’ extension in high radial nerve palsy. This randomized controlled trial study was carried out in the Department of Orthopedic Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka over a period of two years from January 2013 to December 2014. A total of 30 patients with high radial nerve palsy were recruited, 15 patients were gone through Flexor Carpi Radialis tendon transfer procedure (FCR group) and the rest 15 patients were gone through Flexor Carpi Ulnaris tendon transfer procedure(FCU group). The patients were followed up for 12 weeks after surgical intervention. Out of all patients, 86.7% male were encountered in each group. The mean age was found 31.07±9.14 years in FCR group and 33.60±10.79 years in FCU group. Humerus fracture was remained a major cause of radial nerve palsy in both FCR and FCU groups (26.7% vs. 33.3%). In final follow-up at 12th week, no extension deficit was observed at MCP joint (93.3% vs. 80.0%, p>0.05).The end result of surgical intervention was found satisfactory equally in both the groups (86.7%). In case of high radial nerve palsy, both FCR and FCU tendon transfer procedures are effective forfingers’ extension at MCP joint. Bangladesh Med J. 2019 Sep; 48 (3): 9-15

Background: Extensor tendon injuries are very common injuries in hand & forearm, which inappropriately treated can cause severe lasting impairment of hand function of the patient. After the extensor tendons repair whether to immobilization or to early active mobilization is debatable. Objectives: Compare the two common protocols, immobilization vs. early active mobilization by using a simple static splint after surgical repair of extensor tendon. Method: This prospective randomized study was conducted in the Department of Orthopaedic Surgery, BSMMU, Dhaka for duration of January 2014 to December 2017. Forty (40) patients of extensor tendon injuries in zone V-VIII were selected. The patients were divided into two groups by sealed envelope technique, Group A-immobilization group & Group B-early active mobilization group. Extensor tendon was repaired by Doyle proposed technique. Mayo Wrist Score and Dargan criteria were used for evaluation of final result at 12 th months. Results: Most of the patients were in 3 rd decade. Male and right hand injury were predominant in both groups. More than one third, (35.0%) patients were factory worker in immobilization group and 8(40.0%) in EAM group. Majority 17(85%) patients had glass cut injury in both groups. Nine (45.0%) patients had Zone VI injury in immobilization group and 10(50.0%) in EAM group. In immobilization group out of 72 tendon injury EDC injury was 37(51.38%) and in EAM group out of 69 tendon injury EDC injury was 37(53.62%). Complications developed 6(30.0%) in immobilization group and 4(20.0%) in EAM group. Satisfactory outcome was 85% in immobilization group and 95% in EAM group at 12 th months. Assessment at 12 th weeks and 6 th months were statistically significant (p<0.05) but not at 12 th months between two groups. Conclusion: EAM by using simple static splint following extensor tendon repair shown faster recovery, gain complete range of motion and improved grip strength at early post-operative period.

<p><strong>Background:</strong> Cubitus varus is the most common angular deformity resulting from supracondylar fracture of the humerus in children and adults. There are several options for correcting this deformity, but three dimensional osteotomy is now a popular method for the operative treatment of cubitus varus deformity. Objective of current study was to evaluate clinical and radiological outcome of three dimensional corrective osteotmy for cubitus varus deformity.</p><p><strong>Methods</strong>: This prospective interventional study was conducted in the department of orthopaedic surgery, BSMMU, Shahbag, Dhaka from January 2016 to September 2020. Within this period, total 40 cases of cubitus varus deformity, age ranging from 8-20 years that has the inclusion criteria was enrolled as a study sample with proper consent. All the data were analyzed statistically by using SPSS-22.</p><p><strong>Results:</strong> The results of present study showed significantly improved carrying angle, range of motion, internal rotation angle at the time of final follow-up period of six months or more. The outcome of the subjects was graded as excellent in 16 (40%), good in 18 (45%), fair in 4 (10%) and poor in 2 (5%) patients. Excellent, good and fair results were considered as satisfactory outcome and only poor result was considered as unsatisfactory outcome.</p><p><strong>Conclusions:</strong> After analyzing the results of present study it can be concluded that three dimensional osteotomy is a safe technique with satisfactory outcome in treatment of cubitus varus deformity.</p>

Cystic lesions include Simple bone cyst and Aneurysmal bone cyst, and among cyst like lesions studied Giant cell tumor, fibrous dysplasia and Non-ossifying fibroma. This prospective interventional study was conducted in the Department of orthopaedic surgery Bangubandhu Sheikh Mujib Mdical university (BSMMU) and Biomedical research division, Atomic energy centre Savar, Dhaka Bangladesh from January 2004 to December 2019. Out of 155 Cysts and cysts like lesions were operated, among which cystic lesions were 73 (47.10%), among cystic lesions SBC was 51 (69.86%), and ABC-22 (30.14%) and cyst like lesions were 82 (52.90%), among cyst like lesions GCT was 68 (82.92%), FD was 12 (14.63%) & NOF was 2 (2.43%). All cases were operated by thorough curettage and cavity filled with Lyophilized radiation sterilized bone allograft impregnated with autogenous bone marrow for children and mixed bone graft in adult. Clinical and radiological evaluation was done in all cases in which 61 (83.56%) out of 73 cystic lesions were healed and 12 (16.44%) lesions were recurred, on the other hand 58 (70.73%) out of 82 cyst like lesions were healed and 24 (29.27%) lesions were recurred. Out of 155 cysts and cyst like lesions 119 (76.78%) were healed / satisfactory and 36 (23.22%) were recurred. Follow up period were 9 month to 15 years. P value is <.001. Main aims to evaluate the complete healing of cystic and cyst like lesions of bone with in corporation of allograft. Bone marrow impregnated Lyophilized radiation sterilized bone allograft and mixed bone graft is useful graft material for healing of the lesional area and restoring structural integrity as well as function for management of cysts and cyst like lesions in bone.