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Avascular necrosis (AVN) of femoral head is an increasingly common cause of musculoskeletal disability. Most of the cases caused by steroid induced and traumatic but idiopathic cause are not also uncommon. Almost all the patients presented with pain at the hip, limping gait, restricted movement and difficulty in waking and squatting and becomes disabled. Core decompression and muscle pedicle bone graft at stage IIA, IIB and III provides painless and mobile life. Core decompression supplemented with bone graft to enhance mechanical support and augment healing. We have started a prospective study for the treatment of AVN of Femoral head at stage IIA, IIB and III by core decompression and Tensor fascia lata muscle pedicle bone graft in the department of Orthopaedic surgery Bangabandhu Seikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from January 2009 to December 2019. Aim of the study was to assess the effectiveness of core decompression and tensor fascia lata muscle pedicle bone graft in the treatment of AVN of femoral head at stage IIA, IIB and III. A total 48 patients and 65 hips were operated. Out of 48 patients, male was 30(62.50%) and female was 18(37.5%). Male-Female ratio was 1.66:1. Age of the patients ranging from 20 years to 50 years, mean age 36±4.65 years. According to aetiology corticosteroid induced was 47/65 (72.31%), idiopathic was 8(12.31%), post traumatic was 4(6.15%), ITP was 2(3.08%), ALL was 2(3.08%), and alcohol induced was 2(3.08%) of femoral head involvement. According to Ficat and Arlet's staging, stage IIA hip involvement was 28/65(43.08%), stage IIB was 32(49.23%) and stage III was 5(07.69%). All patients were treated with core decompression along with tensor fascia lata (TFL) muscle pedicle bone graft. All patients were followed clinically and radiologically at regular interval. Follow up period was 6 months to 10 years. Harris hip score (HHS) was used for evaluation of clinical outcome. Among the 65 hips, 24(36.92%) was excellent outcome (HHS90), 30(46.15%) was good outcome (HHS: 80-90), 7(10.78%) was fair outcome (HHS: 70-79) and 4(6.15%) was poor outcome. For valid statistical analysis excellent and good results were grouped as satisfactory that was 54(83.07%) and fair and poor results were grouped as unsatisfactory that was11(16.93%), p value is0.001 that is significant. It has been concluded that core decompression and TFL muscle pedicle bone graft is a pain relieving, head preserving procedure and improve hip function for the management of AVN of femoral head in stage IIA, IIB and III.

Osteoarticular allografts have provided the chance of limb-sparing trial in tumor surgery. Several authors have reported 50-75% long term (10 years) successful use of these types of grafts, and large well recognized series provide confirmation that limb reconstruction following extensive resection of bone and joints has been possible with their use. Infection has been a major problem, affecting up to 12 per cent of recipients and often resulting in re-operations and infrequently amputations. This prospective Interventional study was conducted in the Department of Orthopaedic Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU) and Biomedical Research division, Atomic Energy Centre, Savar, Dhaka, Bangladesh from January 2008 to December 2017. In this study patients' age were 20-50 years and male was 12(60%)female was 8(40%). We assessed the results of 20 limb-salvage procedures (Resection-Arthrodesis Procedure) using 11-18cm of distal femur or proximal tibial osteoarticular allografts after wide resection of aggressive or malignant Giant Cell Tumour (GCT) around the knee joint, Campanacci Grade III or recurrent case of Campanacci Grade II. At the ten-year follow-up, two patients had died, one due to infection and tumor metastasis to the lungs and one due to medical causes. The allografts survived for more than five years was twelve patients (60%) all of whom had good function, ranging from 73% to 90% of normal. The allografts were removed because of fracture in two patients and infection in two patients. Remaining three patients allograft was survived with satisfactory function but follow up was 3 years. All postoperative problems related to the allograft reconstruction were documented. Functional outcome was evaluated using the Musculoskeletal Tumour Society Scoring System and at least more than 3 years follow up should be taken for categorization of the results. Among the 20 patients, satisfactory result was 15(75%) patients and unsatisfactory result was 5(25%) patients. P value was0.001.

Unicameral bone cyst is a common benign bone tumor and most frequent cause of the pathological fracture in children. We have started a prospective study for that treatment of unicameral bone cyst by using freeze dried radiation sterilized bone allograft impregnated with autogenous bone marrow in the department of Orthopaedics, Bangabandhu Sheikh Mujib Medical University (BSMMU) during May 1999 to April 2012. Aim of this study was to see Freeze dried radiation sterilized bone allograft impregnate with autogenous bone marrow a satisfactory graft material in the treatment of unicameral bone cyst as well as factors such as patients age, sex, cyst size and site of lesion influence on cyst healing. A total 35 patients of unicameral bone cyst were operated. In this study out of 35 patients, male were 22(62.86%) and female were 13(37.14). Male Female ratio 22:13(1.70:1) Age of the patients ranging from 2 years 6 month to 20 years, mean age 12.18 years more common 11 years to 20 years 29(82.86%) patients. Common bones sites involvements are proximal end of Humerus 20(57.14%), proximal end of Femur 7(20 %), proximal end of Tibia 3(8.57%), Calcanium 2(5.71%), proximal end of Ulna 1(2.86%), shaft of Radius 1(2.86%) and Phalanx 1(2.86%). Final clinical outcome of unicameral bone cyst treated by thorough curettage of cavity and tightly filled with freeze dried radiation sterilized bone allograft impregnate with autogenous bone marrow in which healed (success rate) 88.57% (31) and recurrence rate is 11.43% (4). P value is0.001. Follow up period was 6 month to 11 years. From our study it was realized that freeze dried radiation sterilized bone allograft impregnated with autogenous bone marrow is useful graft material for healing of the lesional area as well as restoring structural integrity for the treatment of unicameral bone cyst.

Non-ossifying fibroma is a common benign bone lesion but extensive involvement of almost whole of the shaft of right tibia is a rare presentation. The patient was a young lady of 35 years admitted at the department of Orthopaedics in Bangabandhu Sheikh Mujib Medical University (BSMMU) on June 2006 with pain and swelling of right distal tibia and unable to walk without support, was diagnosed clinico-radiologically as a case of fibrous dysplasia. The lady was undergone surgery and biopsy confirmed a case of non-ossifying fibroma. Within the follow up period of 28 months, the patient was well with full functional limb and the lesion was also healed radiologically.

Giant cell tumor is a common bone neoplasm. We have initiated a prospective study for the treatment of giant cell tumor of bone by mixed (Autograft+Allograft) bone graft in the department of orthopaedics, Bangabandhu Sheikh Mujib Medical University (BSMMU), during January 2002 to March 2008. A total 28 patients of giant cell tumor of bone were operated. In this study out of 28 cases, male were 11(39.28%) and female were 17(60.72%). Female were predominant. Age of the patients ranging from 11 years to 49 years, mean age 27.03 years. More common in 21 years to 30 years 16(57.14%) of cases. Common sites of lesion were distalproximal end of femur 11(39.28%), proximal end of tibia 6(21.43%), proximal humerus 3(10.71%) and distal radius 3(10.71%). Final clinical outcome of giant cell tumor of bone treated by thorough curettage of the cavity and filled with mixed bone graft (freeze dried radiation sterilized bone allograft+autogenous bone graft) in which success rate is 75%(21) and recurrence rate is 25%(7). P is0.001. Follow up period was 4 months to 4 years. From this study it was realized that mixed bone graft is useful graft material for enhancing osteogenic potential as well as maintaining structural integrity for the treatment of giant cell tumor of bone.