Arthroscopic Anterior Cruciate Ligament Reconstruction with Triplet Autograft of Semitendinosus Tendon.

Anterior cruciate ligament (ACL) is the most commonly injured ligament occurs in young adult population, which markedly reduces activity level. Anterior cruciate ligament rupture is a threat to the homeostasis of the knee. So, reconstruction of the ACL is necessary to make them fit and return to their pre-injury activity level. The choice of graft for ACL reconstruction is a matter of debate, with the BPTB graft and quadruple graft of ST-G being the two most popular options. Use of triplet graft of semi-tendinosus tendon alone without sacrificing gracilis is another option. So hypothesis was Arthroscopic ACL reconstruction with triplet autograft of semi-tendinosus tendon alone is an effective procedure. This prospective interventional study was conducted from October 2011 to March 2013 at Dhaka Medical College Hospital, Dhaka, Bangladesh. Fourteen patients who had a unilateral anterior cruciate ligament rupture underwent arthroscopic reconstruction with triplet graft of semi-tendinosus tendon. Accelerated ACL reconstruction rehabilitation protocol was followed and final outcome evaluation done at 24 weeks according to IKDC knee examination form and Lysholm knee scoring scale. Preoperative Lysholm knee score was 52.64 and postoperative score was 90, that shows significant improvement (p<0.05). According to Lysholm knee scoring scale, excellent results (95-100 points) were obtained in 33% patients, good results (85-94 points) in 53% patients, fair and poor (7% each). For arthroscopic ACL reconstruction, choice of semi-tendinosus tendon alone preserving gracilis, comparable outcome as with BPTB/ST-G graft, can be achieved, minimizing the hamstring strength deficit. Moreover gracilis being reserved for future use in revision ACL reconstruction and/or in other reconstructive surgery.

Correlation of Stature with Foot Length in 5-10 Years Aged Bangladeshi Children.

This cross sectional, descriptive and analytic type study was conducted among 5-10 years aged Bangladeshi children at different areas of Mymensingh district (Fulpur, Muktagacha, Fulbaria, Trisal and Haluaghat) on 109 Bangladeshi children (70 male and 39 female) from January 2016 to December 2016. Sample collection was done by nonrandom purposive sampling technique. Any kind of foot deformity resulting either from congenital or physical injury were excluded to construct standard measurement. The present anthropometric study was designed to construct data of 5 to 10 years aged Bangladeshi children regarding foot length, to measure correlation of stature with foot length and an attempt has been made out to grow interest among the researchers for future study and also to compare the data with the data of the people of other races. Stature of the subject was measured with the stadiometer and foot length was measured using slide calipers. The children were asked to stand with weight distributed equally on both feet. The legs were perpendicular to the feet. The mean foot length of 5, 6, 7, 8, 9 and 10 years aged male were 16.72±1.11cm, 17.12±.72cm, 19.04±1.27cm, 19.10±.76cm, 20.11±1.25cm and 20.88±1.01cm respectively and those of same aged female were 16.44±1.2cm, 17.85±0.50cm, 18.53±0.76cm, 19.14±0.58cm, 19.87±1.88cm and 20.95±1.36cm respectively. Correlation between stature and foot length was made. Foot length showed non- significant positive correlation with stature in 5 years old male and female, 6 years old male, 7 years old male and female, 8 years old male and female, 9 years old and 10 years old female. In case of 9 years and 10 years old male, it showed significant positive correlation with stature. Comparison of foot length between male and female children was done by Unpaired Students 't' test which was statistically non-significant.

Pattern of Head Injuries (Cranio-cerebral) due to Homicide in Association with Other Injuries: A Retrospective Post-mortem Study Autopsied at Dhaka Medical College Morgue House.

Annually, homicide contributes to a greater number of the total head injury cases. This retrospective study was conducted from 1(st) January 2009 to 31(st)December 2011 at Dhaka Medical College Mortuary. During this study period of three years a total of 15300 autopsies were done of which 5649 cases (36.84%) were of head injuries. Of them 747(13.22%) were of homicidal, 4080(72.22%) road-traffic accidents, 502(8.88%) accidental and 320(5.66%) cases of fall from heights. Three hundred ninety eight (398) urban cases (53.27%) out numbered 307 rural cases (41.09%) followed by 42 unknown cases (5.62%). Most cases belong to the younger age group i.e. 21-40 years (43.34%) with male preponderance 470(63.10%). Defense wounds were present in 281 cases (37.82%) out of the total 747 homicidal head injuries. There were 206(27.57%) upper limb, 176(23.56%) spinal, 139(18.60%) abdominal, 135(18.07%) thoracic, 58(7.76%) lower limb and 33(4.41%) pelvic injuries found as associated injury. There were 258(34.53%) fractures of occipital followed by 209(28.29%) parietal, 113(15.01%) frontal, 104(13.75%) temporal, 24(3.21%) ant. Cranial fossa, 23(3.07%) post. Cranial fossa and 16(2.08%) of middle cranial fossa fractures. Extradural haemorrhage was more i.e. 434 cases (58.43%) followed by subdural, combination of all, subarachnoid and intra-cerebral haemorrhages. Cases of concussion were more common i.e. 445(59.75%) than lacerated and combination of them. Blunt weapon tops the list of causative weapons i.e. 669(89.22%) than firearms 59(8.07%) and sharp pointed weapons 19(2.68%).

Ambras Syndrome: First Reported Case in Bangladesh and its Oral Rehabilitation.

People with rare hypertrichosis syndromes became crowd-drawing money-making phenomena in many 19th century sideshow acts. These individuals have been referred to as dog-men, hair-men, and werewolves. In 1993, Baumister et al. described congenital hypertrichosis lanuginose or Ambras syndrome: a distinct form of congenital hypertrichosis characterized by excessive hair growth over the body and face associated with facial and occasional dental anomalies. Much is not known about this syndrome since fewer than 50 cases have been documented worldwide. In this case report, a nine year old girl presented with excessive hair growth throughout her body that was denser along her midline. Furthermore, her face displayed the typical dysmorphic features characteristic of Ambras syndrome: a round tip nose, thickened nasal cartilage, antiverted nares, prominent philtrum with deep groove, and a trapezoid mouth. Oral examination revealed normal oral mucosa with completely missing and unerupted decidious and permanent teeth. Panoramic radiographs confirmed unerupted deciduous teeth. Previous case reports have mentioned the presence of occasional dental anomalies such as retarded first and second dentition and absence of some teeth. However, this is the first reported case of Ambras syndrome presenting with complete anodontia. Prior cytogenetic studies performed on persons with Ambras syndrome have implicated a balanced pericentric inversion of chromosome 8. However, it is likely that dental anomalies are likely a result of a different genetic rearrangement. Further studies are needed to explore the cause of this rare phenotype of Ambras syndrome with complete unerupted dentition.

Outcome of Percutaneous Tenotomy in the Management of Congenital Talipes Equino Varus by Ponseti Method.

Congenital talipes equino varus (CTEV) is a common complex congenital anomaly affecting approximately 1 per 900 live births in Bangladesh. Current trends in the treatment of idiopathic clubfoot have shifted from extensive surgical release to more conservative techniques. The Ponseti method that includes manipulation, serial casting, percutaneous tenotomy and bracing has recently become very popular for the management of CTEV with reported excellent outcomes. The purpose of this study was to evaluate the outcomes of Percutaneous Tenotomy in the treatment of equinus deformity of idiopathic clubfoot. Between June 2012 and November 2013 we treated 47 feet in 34 children by the Ponseti method. The standard protocol described by Ponseti was used. Percutaneous tenotomy of the Achilles tendon was performed under local anaesthesia in the outpatient department of Dhaka Medical College Hospital. The Pirani score was used for assessment and mean follow up time was 12 months. The compliance of percutaneous tenotomy among the 47 feet was recorded and 40(85.1%) were good, 4(8.5%) were fair and 3(6.4%) were poor. The rating of final outcome of percutaneous tenotomy after one year follow-up periods among 47 feet, 36(76.6%) were good, 11(23.4%) were fair and zero (0%) were poor. This study permits to conclude the percutaneous tenotomy in Ponseti method as a safe, effective outdoor procedure to correct the residual equinus deformity of club foot after serial casting.

Endoluminal Ultrasonography versus Computed Tomography for Locoregional Staging of Carcinoma Stomach.

Curative surgery remains the mainstay treatment of carcinoma stomach till to date. Preoperative accurate diagnosis of the depth of tumour invasion (T) and nodal involvement (N) in stomach cancer is important in determining the choice of an optimal therapeutic approach. Endoluminal ultrasonography (EUS) is considered as most reliable tools for assessing locoregional staging as it can overcome bones and air barrier on the other hand computed tomography (CT) has increased its' efficacy greatly after introduction of extreme multi-detector and phase-contrast CT. The objective of this study was to compare the accuracy of T and N staging with EUS and CT by comparing with postoperative histopathology in stomach carcinoma. This cross-sectional observational study was conducted in the department of General Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh from August 2019 to July 2020. Forty five (45) patients who underwent curative stomach resection surgery due to carcinoma of stomach were enrolled in this study. All patients were investigated by EUS and CT preoperatively to assess locoregional staging. Then patients underwent stomach resection surgery and specimen sent for histopathology. EUS had sensitivity 80.0% to predict T staging but specificity 60.0% and the overall accuracy was 68.89%. CT result showed sensitivity 59.38% to predict T staging but specificity 46.15%, and the overall accuracy was 55.56%. EUS had 65.63% sensitivity to predict nodal involvement but specificity 61.54% and the overall accuracy was 64.44%. CT had 83.33% sensitivity to predict nodal involvement but specificity 55.56% and the overall accuracy was 77.78%. EUS is more accurate than CT in T staging but CT is more accurate than EUS in the N staging of carcinoma stomach. So EUS and CT both should be used as a diagnostic tool for preoperative locoregional staging of carcinoma stomach.

Comparison of Pain Control and Analgesic Consumption With or Without Infiltration of Bupivacaine at Port Sites after Laparoscopic Cholecystectomy.

Pain management is an essential component of all surgical procedures. Analgesics are used for this purpose but there are some complications in using them. Local anesthetics like bupivacaine can be used to reduce postoperative pain as well as analgesics consumption. The objective of this study is to observe the result of infiltration of bupivacaine at port sites and to compare the postoperative pain relief with that of opioids and NSAID administration following laparoscopic cholecystectomy for chronic calculus cholecystitis. This is a cross sectional study was conducted over one year in the Department of Surgery of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from September 2018 to August 2019. Here total 40 patients were enrolled by purposive sampling. They were divided in two groups. One group received bupivacaine while other did not. A numerical pain scale was used as tool. Data will be recorded by peer reviewed interview and observation based semi structured data collection sheet. Data analysis was done by SPSS version 23.0. P-value was significant at (p<0.05) and determined by chi square test. Written informed consent was taken from the patient. The mean Numerical Rating Scale (NRS) score of pain at 6 hour was 2.55±0.6 in Group I and 6.8±1.15 in Group II. The mean NRS score of pain at 12 hour was 4.1±1.21 in Group I and 7.95±0.6 in Group II. The mean time of 1st analgesic administration was 13.85±1.57 hours in Group I and 2.75±0.72 hours in Group II. The mean repeat dose of analgesic was in 22±2.29 hours in Group I and 9.5±1.15 hours in Group II. In Group I one third patients (30.0%) single dose analgesic required in 1st 12 hours while in Group II almost 90.0% patients needed analgesics in 1st 12 hours. In Group I, total doses of analgesics required were 2 in 75.0% patients while in Group II at least 3 doses of analgesics were needed. In Group I only one patient needed analgesic in first 6 hours (5.0%) while in Group II, all the patients (100.0%) needed analgesics. The difference was statistically significant (p<0.05) between two groups. The patients receiving bupivacaine at port sites will experience less pain at postoperative period and will need less analgesic medications.

Demographic Characteristics of Patients with Breast Cancer in Bangladesh: A Single-Centre Study.

We performed this study to investigate the socio-demographic factors of breast cancer patients of Bangladesh. This cross-sectional study was conducted in the Department of General Surgery at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from July 2018 to September 2019 for a period of one (1) year. All consecutive cases of breast carcinoma admitted in hospital and attended at outpatient department during the study period were selected as study population. Total 50 patients were selected. The mean age of the study patients was 51.1. Maximum number (70.0% cases) of breast cancer was belonged in 4th to 5th decade aged group. 70.0% breast cancer patients were housewives. The most of the breast carcinoma was reported in the urban people which were 78.0% cases. The percentage of educated study population was 80.0%. On religious background, 86.0% cases of breast cancer patients were Muslim. Most of breast cancer patients were sporadic in origin 94.0% cases, had no family history of breast cancer. Breast cancer was mostly distributed in pre-menopausal aged group with 82.0% cases. Ninety percent (90.0%) of the study population was come from middle class socio-economic group. In western countries, incidence of breast cancer is more in elderly aged menopause women with high socio-economic class. In this study the breast carcinoma was most prevalent among educated urban Muslim pre-menopausal housewives of age group 4th to 5th decade and most of them belonged to middle socio-economic class. The socio-demographic factors of breast cancer patients in Bangladesh are disparate from western countries in age standard, social class group and menstrual status.

Conversion of Laparoscopic to Open Cholecystectomy: Experience in A Tertiary Care Hospital.

Now-a-days Laparoscopic cholecystectomy is regarded as the gold standard treatment for benign gallbladder disease but in certain situations conversion to open cholecystectomy is extremely important for the safety of the patient. The objective of this study was to evaluate the reason for conversion of this operation to open surgery. This prospective study was carried out on 392 patients in a single unit of Department of Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh and in a private hospital from July 2013 to December 2018. Maximum (28.3%) patients were 31-40 years age group. Majority (75.3%) was female and 24.7% were male. It was observed that only 2.1% were converted due to dense adhesion (n=3), severe inflammation (n=2), difficult to define anatomy of Calot's triangle (n=2) and Mirizzi syndrome (n=1). Meticulous dissection and proper case selection can reduce the rate of conversion to open surgery.

Outcomes of Varus Derotation Femoral Osteotomy By Angle Blade Plate in Legg-Calve-Perthes Disease for Patient Above Eight Years of Age in The Lateral Pillar B or B/C Group.

Legg-Calve-Perthes disease (LCPD) that starts after 8 years (late onset) usually follow more aggressive course and the long-term outcome is also poor. Treatment method of LCPD that will produce best results is controversial particularly if the patients are with late-onset presentation. This prospective study was conducted from January 2015 to January 2019 at Dhaka Medical College Hospital and Health N Hope Hospital, Dhaka, Bangladesh. We evaluated the radiographic outcomes for patients who had varus derotation femoral osteotomy (VDRO). We followed up 16 patients who had femoral varus osteotomy. All patients were above 8 years of age at clinical onset. The involvement of femoral epiphysis was in either in B or B/C in lateral pillar classification. All patients had MRI done to confirm radiological diagnosis and classification. The mean age was 9.5 years (range, 8 to 12 years). Final outcome was evaluated by using the Stulberg classification which was radiological. Important exclusion criteria were patient with bilateral involvement and requirement of femoral varus >30 degree. We had 81.25% of our patient with satisfactory outcomes. Among them there were Stulberg grade I, 0 cases; Stulberg grade II, 13 cases (81.25%); Stulberg III, 3 cases (18.75%), Stulberg IV and V both 0 case each. The surgical outcomes for varus derotation femoral osteotomy in late onset LCPD patients over 8 years old were showing the good results than other modalities of non surgical and surgical methods.

A Modified Approach for Harvesting Non Vascularized Fibular Graft for Pediatric Age Group.

The conventional technique of harvesting free non-vascularized fibular grafting is associated with different scale of morbidity and usually a long scar. We follow a technique that causes minimum interference to the surrounding soft tissues to harvest the desired length of fibula. This prospective study was performed at Department of Orthopaedics, Dhaka Medical College Hospital from January 2018 to December 2018. Thirty patients of average age 10.5 years (range 8 to 14 years) were taken up for the study. The fibula was harvested by two separate incisions, 1 cm each at proximal and distal extent of proposed length of graft after elevating the periosteum circumferentially using a periosteum elevator. Compression bandage and above knee plaster immobilization was applied that help to reduce hematoma formation. The mean follow up is 12 months. The patients were evaluated clinically and by radiology. Twenty nine patients showed good results. One patient had delayed wound healing resulting in fair result. This modified approach of harvesting fibula reduces donor site morbidity and is safer and easier than conventional approach.

Role of intraoperative flexible Choledochoscopy in calculous biliary tract disease.

Ninety six percent of patients with overlooked bile duct stones required surgery within 5 years of cholecystectomy, every effort should be made to keep the incidence of retained stones minimum. The facilities of pre-operative ERCP are not always available. Examination of the bile ducts under direct vision with a choledochoscope seems a certain method of ensuring that there are no residual stone. A total of 26 patients were evaluated between the periods of 2004 to 2005. Age of the patients ranged from 20 to 70 years. The mean age is about 45.88 years approximately. Six (23.07%) cases had previous history of cholecystectomy. Peroperatively 14(53.84%) cases had only choledocholithiasis, 6(23.07%) cases had cholelithiasis with choledocholithiasis, 4(15.38%) cases had choledocholithiasis with hepatolithiasis and 2(7.69%) cases had Mirrizi's type II with choledocholithiasis. After Choledochoscopy, 22(84.61%) cases had complete blind clearance, 4(15.38%) cases had incomplete blind clearance. Twenty two (84.61%) cases did not require any Choledochoscopy guided stone extraction. Four (15.38%) cases required Choledochoscopy guided Dormia basket extraction. Twenty two (84.61%) cases have undergone T tube drainage, 4(15.38%) cases undergone Roux-en-Y hepaticojejunostomy who had associated hepatolithiasis. In this series percentage of stone overlooked by instrumental exploration was 15.38 & percentage of residual stone in this study was 0%.

Prospective Study of Deterioration of Quality-of-Life among Elderly Women with Untreated Fracture of Neck of Femur in Rural Areas of Mymensingh, Bangladesh.

Elderly women are very much prone to develop fracture at neck of femur sustained by even minute trauma. Most of the cases are due to fall. Osteoporosis gives rise to this vulnerable condition. In developing countries like Bangladesh the women of rural areas are the prime victims mostly due to illiteracy. To assess the quality-of-life (QOL) of elderly women (>60 years) with untreated hip fractures in a rural areas in Mymensingh, Bangladesh is the objective of this study. This prospective study was done from January 2019 to December 2019 in Orthopaedics and Traumatology Department of Mymensingh Medical Hospital, Mymensingh, Bangladesh. Twenty-five elderly women with untreated fracture neck of femur were enlisted in this study. EuroQol (EQ-5D) was applied to assess the Quality of life of subjects before and after the situation. Twenty-five elderly women of healed operated neck of femur were included as comparison group, matched for age, economic condition and educational status among neighborhood people. So, sample size was fifty. Wilcoxon signed rank test and Mann-Whitney U test were applied to compare EQ-5D mean scores. Participants with hip fracture, 60% (15/25), 68% (17/25), 68% (17/25), 60% (15/25) and 92% (23/25) reported severe problems with mobility, pain, usual activity, self-care and anxiety respectively. The EQ-5D mean score among the elderly with fracture neck of femur was 0.198 (SD 0.14). It was low when compared with the same subjects before the occurrence of the event (Z-6.522, p<0.001) and as compared with the comparison group (Z-7.92 p<0.001). QOL scores assessed using EQ-5D index scores was poor among elderly women with untreated fracture neck of femur as compared with the healed operated comparison group. Vast majority of study participants in this study were reported severe problems like mobility, pain, usual activity and self-care and anxiety.

Serum Electrolyte, Serum Calcium and Blood Sugar Status in Severe Acute Malnutrition and Their Relationship with Edema, Vomiting and Diarrhea.

Severe acute malnutrition (SAM) is the most severe form of protein energy malnutrition (PEM). Few studies found serum electrolyte, serum calcium level changes as important factors of poor outcome. Hypoglycemia is already established as a risk factor for death in severe acute malnutrition. Edema, diarrhea and vomiting are commonly present in severe acute malnutrition which has impact on electrolyte balance and blood sugar level in healthy children. Their impact in severe acute malnutrition is not clearly established. This cross sectional descriptive study was conducted in Department of Pediatrics, MMCH from March 2018 to October 2019 to estimate serum electrolyte, serum calcium and random blood sugar level in severe acute malnutrition and their relationship with edema, vomiting and diarrhea. Forty-one (41) cases of SAM were enrolled in this study. Test samples were collected before starting the treatment. Case record form was used to collect information. Cases were divided into Group A and Group B based on the presence or absence of vomiting or diarrhea, respectively. Again, all cases were divided into Group C and Group D based on presence or absence of edema, respectively. Data were analyzed using IBM SPSS statistics version 23. Mean age was 9.71±10.4 months with 85.36% having age less than 1 year. Twenty-four (58.5%) were male and 17(41.5%) were female. Parents had low level of education with 48.8% mother and 51.2% father having primary education or no education. Higher number of serum electrolyte, serum calcium and blood sugar were found with hyperglycemia present in 29.3%, hypocalcemia in 22%, hypokalemia in 22% and hyponatremia in 19.5% cases. Hypokalemia was present more in SAM with vomiting or diarrhea (p=0.008). Other disturbances do not vary on presence or absence of edema and vomiting or diarrhea. Result of the present study shows hypokalemia is associated with SAM with vomiting/diarrhea. Hypocalcemia, hyperglycemia, hyponatremia and hypernatremia were also present in high number. These changes should be detected early and treated accordingly.

Evaluation of Surgical Correction of Adolescent Idiopathic Scoliosis by Transpedicular Screws and Rods.

Transpedicular screw fixation is a challenging procedure for the correction of deformity of Adolescent Idiopathic Scoliosis (AIS) in the dorso-lumbar spine. The inadvertently misplaced screws have a high risk of complications. The exactness of the pedicle screws is normally distinct as the screws axis being fully enclosed within the cortices of the pedicle. Evaluation of the surgical correction of adolescent idiopathic scoliosis by transpedicular screws and rods was done in single posterior dynamic approach. This prospective observational study was conducted in the National Institute of Traumatology and Orthopedic Rehabilitation, Dhaka and different Hospitals in Dhaka, Bangladesh from July 2015 to March 2017. Ten patients at the age >9 years and <19 years who were admitted with a diagnosis of AIS during the period of study. The pedicle is a power nucleus of the vertebra and offers a secure grip of all 3 columns. Pedicle screw instrumentation has advantages of rigid fixation with improved 3D correction and it has been accepted as a reliable method with a high margin of safety. Accurate placement of the pedicle screws is important to reduce possible irreversible complication. So, all cases were corrected by transpedicular screws and rods in single posterior approach. In every case fusion was done in selected segments. In this study out of 10 patients 7(70.0%) were 10 to 14 years of age and 3(30.0%) were 15 to 18 years. Mean age 9.51±2.13 years. Minimum 10 years and maximum 18 years. Majority 7(70.0%) of the patients were female and the rest 3(30.0%) male. Five (50.0%) presented with level of involvement, 3(30.0%) patients thoracic and 2(20.0%) patients had lumbar. Maximum 7(70.0%) presented right sided involvement and rest 3(30.0%) left sided involvement. Before surgical intervention 100% patients had rib hump and positive Adams forward bending test, 70.0% patients had asymmetry of shoulder and uneven hip and also 50% patients had pain. After surgical treatment with transpedicular screws and rods through posterior approach, 70% of patients improved in terms of deformity. The average major curve deformity as defined by Cobb angle measurements was measured to be 54.9°±9.9° (40°-68°) in pre-surgery. After surgery this deformity corrected to 16.0°±4.9° (10°-24°) on average as measured in erect posture posterior anterior and lateral view. This represents significant improvement average of 71.4±4.3% (64.6-75.09) (p<0.001). This correction was maintained at 24 months after surgery. Functional results assessed by Modified Macnab criteria, significant number of 7(70.0%) patients had excellent outcome, 2(20.0%) patients had good outcome, 1(10.0%) patients had fair outcome and no poor outcome. Ninety percent (90%) patients had satisfactory results. No patient deteriorates neurologically after surgery. It is concluded that satisfactory curve correction and maintenance thereof is possible in adolescent idiopathic scoliosis, with posterior instrumentation by transpedicular screw and rods with effective reduction of cost and associated risks.

A Postmortem Study of Length & Depth of the Central Sulcus in Different Age & Sex Groups of Bangladeshi People.

The central sulcus (CS) is a prominent landmark of the brain, separating the parietal lobe from the frontal lobe and the primary motor cortex from the primary somatosensory cortex. Variations in the morphology of the central sulcus are seen with respect to the length and depth of the central sulcus. This study was done to establish a normal standard of length and depth of central sulcus in different age and sex groups of Bangladeshi people. Interhemispheric age and gender differences of the central sulcus were done by cross sectional descriptive study which was performed into four categories- Group A (20 to 29 years), Group B (30 to 39 years), Group C (40 to 49 years) and Group D (50 years & above). The specimens were collected from morgue in the department of Forensic Medicine, Mymensingh Medical College, Bangladesh by purposive sampling technique. The length of central sulcus was measured by using thread and the depth was measured by using wooden stick at middle of the upper, middle and lower third of the central sulcus in superolateral surface. The mean length of central sulcus was 10.51±0.529cm to 9.78±0.996cm in male and 10.27±0.786cm to 8.83±0.379cm in female. Depth of the central sulcus was 1.333±0.100cm to 1.029±0.125cm in male and 1.173±0.144cm to 1.01±0.200cm in female. The difference in mean length & depth of the central sulcus for both left and right hemisphere between male and female was statistically non significant in all age groups. In present study the length and depth of the central sulcus showed gradual decreasing values with advancing age. Knowledge of morphometry of central sulcus is not only important during neurosurgery of brain but also holds tremendous significance in diagnosis and management of diseases of the cerebral cortex. The present study will help to increase the information pool on the length and depth of the central sulcus of Bangladeshi people which will minimize the dependency on foreign standards.

Clinical Outcome in Intra Articular Distal Humerus Fractures in Adults Treated with Different Hardware in a Tertiary Level Hospital of Bangladesh.

In adults, distal humerus fractures are infrequent and frequently intra-articular. Customarily encompass both medial and lateral columns. Operative management gives constructive outcomes. The aim of this study was to evaluate clinical outcome in intra articular distal humerus fractures in adults treated by different hardware. This prospective study consists of 20 purposively selected patients with intra articular distal humerus fractures treated by surgical intervention with different hardware who were admitted to Mymensingh Medical College and Hospital, Bangladesh in between November 2016 to October 2018. Surgical approaches were standard dorsal with or without olecranon osteotomy. The mean age of the patients was 32.3 years, range between 18-55 years. The maximum patients i.e. 85% were between 18-45 years. Seventy percent (70%) of the cases admitted were due to Road traffic accident (RTA). Most of the patients were males 14(70%) with right upper limb was involved in 13(65%) cases. Mean Mayo Elbow Performance Score was 81.5 post-operatively. According to Mayo Elbow Performance (MEP) score clinical outcome was excellent in 20%, good in 50%, fair in 25% and poor in 10% of patients. Distal humerus fractures are censorious in nature. Proper anatomical articular reconstruction and stable fixation by surgical intervention helps in fruitful results.

Management of Fractures of the Distal Third of Tibia by Distal Tibial Locking Plate by MIPO Technique.

Distal tibial fractures are difficult to manage as the bone is subcutaneous with depleted muscular cover; the consequent decreased vascularity leads to complications. Minimal invasive plate osteosynthesis (MIPO) is a very good option for managing this type of fractures. This study was carried out to evaluate the outcome of patients treated with distal tibial locking plate by MIPO technique. Twenty patients with distal tibia fractures treated with distal tibial anatomical locking plate were prospectively studied from July 2013 to December 2016. The result was excellent in 18(90%) of patients i.e. 18 patients had an AOFAS score of 90 or greater out of a possible 100 points. The mean score was 94.28; the mean time for radiological union was 20.1 weeks with a range of 16 to 30 weeks. We encountered superficial infection in 02 (10%) of our patients which were managed with dressings and appropriate antibiotics. Two patients had union with valgus angulation of less than 5°. No malunion was detected. One patient had ankle stiffness requiring extensive physiotherapy to regain range of movement. Plate removal was done in 4 cases. MIPO technique is a good fixation method for fractures distal third of tibia, preserving blood supply & fracture hematoma.

Clinical Outcome on Comminuted Femoral Shaft Fractures in Adults Treated by Minimally Invasive Plate Osteosynthesis (MIPO) with Locking Plate.

Intramedullary nailing is a pillar in the treatment of femoral shaft fractures. But it is not possible in all cases especially in comminuted fractures. This study has been designed to explain the importance of Minimally Invasive Plate Osteosynthesis (MIPO) with the locking plate in the treatment of comminuted Femoral Shaft Fracture. Twenty (20) such patients were treated by MIPO and analysis has been done in this study to get fruitful result and to find out the effectiveness of this procedure who were admitted at Mymensingh Medical College Hospital, Mymensingh, a tertiary level hospital of Bangladesh from February 2018 to January 2019. Mean age of the patients were 49.20±14.41 years. Based on AO classification, there were 4, 8 and 8 patients belong to type A, B and C respectively. The union period for all the patients was in between 12 to 14 weeks. The mean union period was 12.90±1.997 weeks. Mean follow up period was 19.70±2.77 weeks. Mean full weight bearing period was 16.50±1.10 weeks. In Thoresen scoring system excellent result was 9(45%), good result was 10(20%) and fair result was 01(5%). Mal-alignment happened in two cases. However, delayed union and broken screws were found in two cases each of which was treated accordingly. Comminuted Femoral shaft fracture with MIPO procedure is more effective treatment than intramedullary nailing. Furthermore, mal-alignment is the basic complexity that must be taken away intraoperatively.

Core Decompression with Non Vascularized Fibular Graft as Modern Surgical Treatment of Early Hip Avascular Necrosis.

Cellular death of bone due to impairment of the blood supply leading to collapse resulting in pain, and loss of joint function is known as avascular necrosis (AVN). The head of femur is the most common bone affected by avascular necrosis followed by talus and scaphoid. We evaluate the results of core decompression with non-vascularized fibular graft in avascular necrosis of femoral head. This quasi experimental study was done at Mymensingh Medical College Hospital, Dhaka Medical College Hospital and some other private hospitals of Bangladesh. The study includes patients who underwent core decompression and non-vascularized fibular grafting in avascular necrosis of femoral head from January 2017 to December 2018. In this study we evaluated total 20 patients and majority of the patients belongs to the group of 20-30 years. Out of 20 patients, 8 of them were unilaterally involved rest 12 had bilateral involvement. Out of 24 hips of bilateral involvement 4 were grade III and IV (Ficat and Arlet classification) therefore not included in the study. So, we study 28 hips only. The average success rate was 90% after core decompression and non-vascularized fibular bone grafting. Harris hip score of 60 on presentation had poorer outcome. Patients with less than 80 degrees of flexion had poorer outcome.