Epidemiology of Spinal Trauma and Related Complication.

BACKGROUND: Traumatic spinal injury is leading cause of mortality and morbidity among the people of productive age group. This study aim to find the cause of spinal injury, site ,and mode of injury, treatment option given so that a preventive measures and create awareness among people of this region. METHODS: This is a prospective observation study done in Karnali Academy of Health Sciences from December 2021 to January 2023. Performa was filled to collect data. Data were entered in excel sheet and transported to SPSS 16.0 and statistical analysis was done . RESULTS: Out of 117 patients male population had higher incidence of spinal trauma (69.2%) with average age 43.9 years . Fall injury was the commonest mode of injury. 65.8% had injury at the thoracolumbar junction followed by lumbar, thoracic and cervical respectively. Cervical injury patients had higher incidence of neurological deficit. The average duration of trauma to hospital presentation was 10.9±11.2 hours. 19.7 % were operated and 6.8 % of patients were referred to other center. CONCLUSIONS: Fall injury being the commonest mode of injury in this art of world, prevention and awareness should be raised about the spinal trauma and its consequences. Adequate equipment with health facilities to the distant hospital may reduce the referral rate and duration of presentation to the hospital which ultimately prevent the further damage to the cord.

de Quervain's Disease among Patients Visiting the Orthopaedic Outpatient Department of Tertiary Care Center: A Descriptive Cross- sectional Study.

Introduction: de Quervain's disease is one of the common causes of wrist pain. It can cause serious disability and absence from work due to impaired functioning of the wrist and hand. The aim of this study is to find out the prevalence of de Quervain's disease among patients visiting the orthopaedic outpatient department of a tertiary care centre. Methods: This was a descriptive cross-sectional study conducted among patients visiting the orthopaedic outpatient department of a tertiary care centre after receiving ethical approval (IRC KAHS Reference: 078/079/56). This study was conducted from 1 January 2021 to 30 December 2021 from hospital medical records. A convenience sampling method was used. Patients with de Quervain's disease from 16 to 60 years were included in this study. Clinically diagnosis of de Quervain's disease was based on the tenderness of the radial styloid process, tenderness over the first extensor compartment on resisted thumb abduction or extension and positive Finkelstein test. Point estimate and 95% Confidence Interval were calculated. Results: Out of 9600 orthopaedic outpatients, de Quervain's disease was seen in 128 (1.33%) (2.68-4.52, 95% Confidence Interval). Conclusions: The prevalence of de Quervain's disease was similar when compared to other studies conducted in similar settings. Keywords: de Quervain's disease; surgery; tenosynovitis.

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.

Spectrum of Diseases among Neurosurgical Patients in a Tertiary Care Hospital of Nepal: A Descriptive Cross-sectional Study.

INTRODUCTION: The number of neurosurgical cases, especially traumatic injuries, are increasing in remote settings. This study aims to determine neurosurgical cases in a tertiary care center teaching hospital situated in a remote area of Nepal. METHODS: It was a descriptive cross-sectional study among 138 neurosurgical patients at Karnali Academy of Health Sciences from 2019 August to 2020 July. A convenient sampling technique was used. The demographic data, the diagnosis, and management offered were recorded, reviewed, and analyzed using Statistical Package for Social Sciences version 16 and Microsoft Excel. RESULTS: Out of 138 cases, trauma was the main finding in 102 (73.91%) cases, and fall injury was the most frequent mechanism of injury in 64 (46.38%) cases. Traumatic brain injury was the most common disease in 85 (61.6%) cases followed by prolapsed intervertebral disc in 11 (8%), Spine fracture/dislocation in 11 (8%), stroke in 7 (5.1%), spondylosis in 6 (4.3%) and so on. Among the Traumatic Brain Injuries, normal findings were noted in 28 (20.3%) cases, extra dural hemorrhage in 12 (8.7%), contusion 11 (8%), and skull base fracture in 7 (5.1%). With a mean age of 29.8 years, a maximum number of the cases were 30 (21.74%) from the age group 31-40. CONCLUSIONS: Trauma was seen in a majority of neurosurgical cases. Hematoma, depressed skull fracture, and spinal fractures were the main findings of neurosurgical cases. The burden of neurosurgical cases in this part of the world is quite high, so necessary step should be taken to increase such services.

Complication of Early Application of One and a Half Hip Spica for Femoral Shaft Fractures in Children below Six Years in a Tertiary Care Hospital: A Descriptive Cross-sectional Study.

Introduction: Hip spica with or without prior traction has become a standard treatment for closed isolated femoral shaft fracture in children below six years. The time of hip spica application is not uniform in the existing literature. The aim of this study is to find out the prevalence of complication of early application of one and a half hip spica for femoral shaft fractures in children below six years in a tertiary care hospital. Methods: A descriptive cross-sectional study was done among 42 children who were managed with early hip spica application (within 72 hours) for femoral shaft fracture from January 2015 to December 2020 after receiving ethical clearance from Institutional Review Committee. Convenient sampling technique was done. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Complication was seen in nine (21.4%) (95% Confidence Interval= 9.02-33.84) patients. Skin breakdown from local pressure had the highest prevalence in our study which was documented in three (7.14%) patients who resolved with conservative treatment. Conclusions: The prevalence of complication of early application of one and a half hip spica for femoral shaft fractures in children below six years was similar to other studies done in similar setting.

Outcome of Neglected Elbow Dislocation Treated with Open Reduction at Rural Tertiary Care Hospital in Nepal.

BACKGROUND: Chronic unreduced dislocation of elbow is a rare injury. Treatment options include open reduction internal fixation with K wire, replacement arthroplasty, excisional arthroplasty, arthrodesis, and hinged external fixator. The aim of this study is to determine the outcome of open reduction internal fixation with trans-olecranon K wire for neglected elbow dislocation. METHODS: This is a retrospective study done in three rural hospital of Karnali. Hospital records were reviewed from July 2015 to May 2018 to identify 11 cases who underwent open reduction internal fixation for neglected elbow dislocation. Pre and Postoperative outcome was assessed using range of motion and Mayo Elbow Performance Index. Data analysis was done using SPSS version 17. RESULTS: The average age of patient was 22.7 years (range 9-50 years). Non dominant hand was involved in 54.55%. The average preoperative elbow extension was 5.9 degree whereas postoperative extension was 15.9 degree. The average preoperative and postoperative elbow flexion was 24.5? and 113.6? respectively. Preoperative and postoperative Mayo elbow performance index was 18.6 and 86.3 respectively. Outcome was excellent in four patients, good in five patients and fair in two patients with one case having superficial infection. CONCLUSIONS: Open reduction and internal fixation with trans-olecranon k wire is an effective treatment method for neglected elbow dislocation. Postoperatively, elbow function is better with minimal complications.

Epidemiology of Femur Fractures in Children: A Descriptive Cross Sectional Study Based on a Rural Population of Nepal.

INTRODUCTION: Femur fracture in children is one of the most common lower limb fractures which require inpatient care. The aim of this study is to determine the epidemiology of femoral shaft fractures in children from a rural population of Karnali Nepal. METHODS: Hospital records were retrospectively reviewed from May 2017 to April 2020 to identify all the children with femur fracture. Sociodemographic profile, mode of injury, fracture pattern and location, time of presentation, initial treatment by traditional bone setters, treatment method and duration of hospital stay were noted. Data analysis was done using Statistical Package for Social Sciences version 20. RESULTS: Altogether 104 children were identified. The mean age was 5.55 years and boys predominated 65 (62.5%). Falls were the major mode of injury in 65 (62.4%) patients. Fractures were frequently noted between April 15 to August 15. There were four (3.8%) open fractures and concurrent fracture observed in eight (7.6%) patients. Ten (9.6%) children received prior treatment from traditional bonesetters. Treatment methods included hip spica 62 (59.6%), elastic intramedullary nailing 30 (28.8%) and plate fixation 12 (11.5%). The duration of hospital stay in the nailing and plate fixation group was 11.43 days and 18 days respectively. CONCLUSIONS: Fracture was common in 2-6 years of age group in boys during summer. Fall from cliff, rooftop and ladder were the major preventable cause of fracture. Delayed presentation and prior treatment with traditional bone setters add special challenges to orthopedic surgeons working in rural teaching hospital.

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.

Orthopaedics Practice in a Rural Hospital During the COVID-19 Pandemic: A Descriptive Cross-Sectional Study.

INTRODUCTION: The coronavirus disease 2019  pandemic is one of the biggest public health challenges that we have faced, and has had a significant impact on the delivery of essential healthcare worldwide. Trauma and orthopaedic surgery was one of the most severely affected specialties as all non-emergency surgical cases were cancelled. With the possibility of future peak of corona virus, knowing the impact of Covid on orthopaedics would enable us to manage trauma patient in an effective manner and will help us to resume normal schedule of the trauma care. METHODS: This is a descriptive cross-sectional study. We studied the details of total number of patient at Orthopaedic and trauma outpatient, inpatient and operation theatre of Karnali Academy of Health Sciences from 14th March 2020 to 16 September 2020 as compared with the patient data from the same time period in 2019. RESULTS: There were 2288 patients during the non-Covid period who visited to the orthopaedic outpatient in comparison to 1618 during Covid period. Only 5 implant removals were performed in comparison to 50 removals (90% reduction) in elective cases. But the number of surgical cases was almost similar (204 vs 207 respectively). Total number of hospital stay had significantly reduced in the non-COVID period (average 4 days vs 6 days).There were 181 in-patient admissions during the COVID period while 241 admission during the non-COVID period. CONCLUSIONS: There is reduction in number of orthopaedic and trauma cases during COVID 19 with marked reduction in number of elective cases. Alternative methods of treatment like telemedicine and small scale health camps at peripheral districts should be conducted to treat non-urgent orthopaedic conditions during lockdown.