Knee osteoarthritis (OA) is a disabling joint condition that leads to extreme morbidityand quality of life impairment, particularly among older adults. This study aimed to investigate the socio-demographic factors and comorbid conditions influencing the severity of symptoms of knee OA using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Data were derived from 622 patients across 9 months from the major healthcare facilities of Dhaka. This study found age, sex, educational status, obesity, diabetes mellitus, and cardiovascular disease (CVD) were predictors for the severity of symptoms of OA of the knee. Female participants were more prone to have severe symptoms compared to males, and those who were more than 70-years-old were at greater risk of severe symptoms. Low educational status, obesity, diabetes mellitus, and CVD were also predictors for severe OA of the knee. Age (p < 0.001), obesity (p < 0.001), and diabetes (p < 0.001) were the best predictors of severity of symptoms based on the multinomial logistic regression analysis. The findings from the study highlighted the associated factors of knee OA and the need for integral healthcare measures that address both the socio-economic and the physical determinants. Focused interventions need to be employed, particularly for high-risk groups such as the elderly, women, and the comorbid, to minimize the incidence of OA of the knee and maximize the outcomes for patients in settings such as that of Bangladesh, where resources may not be available.
Background: Rehabilitation is a core component of universal health coverage, yet it remains inadequately integrated into primary healthcare systems in many low- and middle-income countries, limiting early intervention, functional recovery, and long-term quality of life. This study aims to explore global models and innovative strategies for strengthening the integration of rehabilitation into primary healthcare in Bangladesh to inform context-appropriate policy and service reforms. Methods: A narrative review was conducted using a structured literature search of major bibliographic databases (Sciverse Scopus, PubMed, Embase, Web of Science, and Cochrane Library) and World Health Organization institutional repositories for literature published between 2014 and 2025. The search terms covered rehabilitation integration, primary healthcare, health system strengthening, and technological innovations. Studies from global and low- and middle-income countries were prioritised. Study selection and screening followed a structured selection process, and the included studies were thematically synthesized to develop a context-specific framework for Bangladesh. Results: Physical disabilities represent a significant share of rehabilitation needs; however, access to and the quality of available rehabilitation services remain limited. In Bangladesh, service provision is primarily influenced by three factors: inadequate physical infrastructure, shortages of trained personnel, and insufficient financing, which contribute to the concentration of services in urban areas. Although community-based rehabilitation initiatives have demonstrated improved service reach and acceptability, the integration of physical and mental health rehabilitation within primary healthcare remains limited. International experiences, including Chile’s comprehensive rehabilitation system and selected models from the Brazil, Russia, India, China, South Africa countries, highlight effective approaches to integrating rehabilitation into primary healthcare. Technological applications, particularly telerehabilitation and other low-cost digital platforms, have the potential to expand access to services. Conclusion: Strengthening rehabilitation in Bangladesh’s primary health care requires integrating basic services, training health workers, and establishing referral pathways, alongside expanding low-cost digital and community-based care to improve access in underserved areas.
Background: Compartment syndrome is a limb-threatening orthopedic emergency characterized by increased pressure within an osteofascial compartment, leading to impaired tissue perfusion and potential irreversible necrosis. Although most frequently associated with tibial fractures, it can also occur in the hand, foot, forearm, and paraspinal muscles. Methods: This review synthesizes current evidence on the definition, epidemiology, pathophysiology, clinical features, and diagnostic approach to compartment syndrome. Literature was systematically searched across PubMed, Scopus, Web of Science, and Cochrane Library using Boolean operators. Risk of bias was assessed with the Cochrane Risk of Bias tool for randomized trials and the Newcastle-Ottawa Scale for observational studies. Results: Approximately 69% of compartment syndrome cases are associated with fractures, with 30% involving the tibia. Pathophysiological mechanisms are explained by the arterio-venous gradient theory and ischemia-reperfusion syndrome, both of which describe a vicious cycle of reduced capillary perfusion, metabolic deficit, ischemia, and necrosis. Clinically, the condition presents with severe pain disproportionate to injury, pain on passive stretch, paresthesia, and tense swelling, summarized by the “6 Ps.” Diagnosis remains primarily clinical, but adjunctive investigations such as radiography can identify underlying fractures, while compartment pressure measurement provides objective confirmation in equivocal cases. Conclusion: Early recognition and timely diagnosis are critical in preventing irreversible damage in acute compartment syndrome. While clinical evaluation remains the cornerstone of diagnosis, adjunctive tools such as imaging and pressure monitoring may assist in difficult cases. Prompt surgical intervention with fasciotomy offers the best chance of preserving limb function. Keywords: Acute compartment syndrome, Intracompartmental pressure, Fasciotomy, Tibial fracture, Diagnosis, Near-infrared spectroscopy.
This study examined the reliability and consistency of the evaluation process used in selecting recipients for the annual Société Internationale de Chirurgie Orthopédique et de Traumatologie (SICOT) Research Award. The primary aim was to assess both inter-rater and intra-rater reliability among the assessors and to evaluate the internal consistency and discriminative capacity of the scoring criteria. A total of 45 anonymised research applications were scored by eight members of the SICOT Research Award Selection Committee. Each application was evaluated across 10 criteria using a 5-point Likert scale, with a maximum total score of 50. The study employed intraclass correlation coefficients (ICCs) to assess reliability, Cronbach's alpha to measure internal consistency, and discrimination indices to evaluate the performance of individual scoring items. The results revealed significant variability between assessors. Inter-rater reliability was poor, with ICCs of 0.289 and 0.190 across two evaluation rounds, suggesting inconsistent scoring among different assessors. In contrast, intra-rater reliability, measuring the consistency of individual assessors over time, showed moderate to good agreement, with an ICC of 0.705. The scoring system exhibited excellent internal consistency (Cronbach's alpha = 0.926), which improved to 0.954 when the "Language" criterion was excluded, indicating that this item may reduce the coherence of the scale. While high internal consistency (Cronbach's alpha > 0.90) indicates reliability, it may also reflect redundancy and a potential halo effect, and should therefore be interpreted as a limitation rather than a strength. All 10 criteria demonstrated acceptable discriminative power, with the "Aesthetic" item scoring the lowest and the total score showing the highest discrimination index. These findings highlight the strengths and limitations of the current evaluation framework. While the scale itself is internally consistent and capable of differentiating between high- and low-quality applications, inconsistencies in inter-rater scoring point to a need for clearer guidelines and more structured assessor training. The study recommends refining the scoring rubric and exploring AI-based tools to support more objective and transparent evaluation in future selection cycles.
Background: Fractures of the femoral neck pose a major challenge to orthopedic practice with the potential for severe complications such as non-union or avascular necrosis. Biplane Double-Supported Screw Fixation (BDSF) is an innovative procedure that aims to improve fixation stability with maximum cortical support. This study aimed to assess radiological union and early hip function following biplane double-supported screw fixation in patients with femoral neck fractures. Methods: A prospective observational study was performed at the National Institute of Traumatology and Orthopedic Rehabilitation in Dhaka from July 2018 to June 2020. A total of thirty-one adults with femoral neck fractures (Garden I-III) were operated on using the BDSF procedure. All patients were given standardized preoperative care, surgery, and postoperative care. Outcome measurement was done via radiologic union and the Harris Hip Score at the end of six months. Data were analyzed using SPSS version 26. Results: The mean patient age was 42.68 ± 16.56 years with a male predominance of 61.29%. Road traffic accidents accounted for 83.87% of the injury causes. Mean radiological union time was 17.9 ± 3.9 weeks, which was significantly shorter for Garden I-II fractures (17.3 ± 3.8 weeks) versus Garden III fractures (22.0 ± 1.6 weeks) (p = 0.01). A union was achieved by 96.77% of the patients. Complications were observed in 16.13% of the total, including wound infection (6.45%), delayed union (6.45%), and non-union (3.23%). HHS at final follow-up. Conclusion: Biplane double-supported screw fixation provides reliable early radiological union with good restoration of hip function in femoral neck fractures, particularly in younger patients and minimally displaced injuries.
