Bear Maul Injury among Patients Presenting to the Department of Surgery in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Bears are robust and agile wild creatures that can potentially inflict injuries. Black bears (Ursus thibetanus) are an inhabitant of the mountainous part of Nepal. Encounters between humans and bears generally occur in the bear-prevalent areas of Nepal and the world inflicting complex categorical injuries. The aim of the study was to find the prevalence of bear maul injury among patients presenting to the Department of Surgery in a tertiary care centre. Methods: A descriptive cross-sectional study was done in the Department of Surgery in a tertiary care centre from 1 August 2017 to 1 September 2022. Data was collected from the records of the Department of Surgery after receiving ethical approval from the Institutional Review Committee (Reference number: 078/79/38). The collected data included time of arrival in the hospital, type of bear, types of laceration, wound type, and demographic of patients. Convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Results: Among 2980 patients presenting to the Department of Surgery, the prevalence of bear maul injury was 15 (0.50%) (0.25-0.75, 95% Confidence Interval). Of which, all had laceration injury, with the face and scalp 9 (60%) being the highest injured site. Autumn was the season attacked most in daytime. Conclusions: The prevalence of bear maul injury was lower than in other studies done in similar settings. Keywords: bears; injuries; lacerations; Nepal; prevalence.

Pattern of Pediatric Supracondylar Fracture Operated at A Rural Teaching Hospital of Nepal: A Descriptive Cross-sectional Study.

INTRODUCTION: Supracondylar fracture of humerus is one of the common pediatric fractures encountered in our daily clinical practice. The purpose of this study is to determine the pattern of supracondylar fracture operated at rural teaching hospital of Jumla, Karnali Nepal. METHODS: A descriptive cross sectional study was conducted at Jumla, Karnali after Institutional Review Committee approval. Operating room notes from 15 May 2017 to 16 November 2019 were retrieved to gather the following information: patients address, age, sex, side, injury mechanism, displacement, neurovascular injury, concurrent injuries, initial management by traditional bone setters, time between injury and surgery, operative technique. Data analysis was done using Statistical Package for Social Sciences version 20. RESULTS: Left side predominated with 88 (63.7%) and extension type was common in 135 (97.8%). Thirteen (9.4%) patients were initially managed by traditional bonesetters. A total of 138 children underwent operative fixation with mean age of 7.47 years and gender ratio of 2:1 boy to girl. Fall from cliff, ladders and rooftops were the prevailing cause of injury 73 (52.8%). Average time between injury and surgery was 5.2 days. Closed reduction was done in 100 (72.4%) patients whereas open reduction was necessary in 38 (27.5%) patients. CONCLUSIONS: Closed extension type pediatric supracondylar fracture was common in this study. Fall from cliff, rooftop and ladder are the major cause of fracture. Delayed presentation and initial management of the fracture by the traditional bonesetters makes supracondylar fracture more challenging in resource limited setting like ours.