Introduction: Total knee arthroplasty is one of the most successful orthopedic surgeries performed in recent decades. However, there are controversies regarding the simultaneous or staged bilateral total knee arthroplasty. The aim of this study is to find the prevalence of bilateral total knee arthroplasty in elderly patients among severe osteoarthritis of knee joints in a tertiary care hospital. Methods: This is a descriptive cross-sectional study conducted from hospital records of 2015 to 2019 in elderly patients with severe osteoarthritis in a Tertiary Care Hospital. Ethical clearance (20/2020) was taken from Institutional Review Board. Convenience sampling was used and statistical analyses were performed using the Statistical Package for the Social Sciences software (version 16.0). Point estimate at 95% confidence interval was calculated along with frequency and proportion for binary data. Results: Out of 1200 patients with severe osteoarthritis, the prevalence of bilateral total knee arthroplasty was found to be 80 (6.67%) (95% Confidence Interval = 6.60-6.74). The mean Knee Society Score was 36±3.70 preoperatively. There were 21 (26.2%) patients having hypertension, 17 (21.2%) diabetes mellitus, 14 (17.5%) chronic obstructive pulmonary disease and 7 (8.7%) coronary artery disease. Conclusions: Bilateral simultaneous total knee arthroplasty was required in less patients with severe osteoarthritis of knee joints. Bilateral simultaneous total knee arthroplasty is safe, convenient, effective with early functional recovery, higher patient satisfaction and cost effective with acceptable cardiac, pulmonary and neurological complications in properly selected patients.

Breakage of tension band wires, used to treat the patella fracture, is not uncommon several years after the fracture fixation. Broken wires may migrate to surrounding neurovascular structures, other vital organs like heart and may cause potentially fatal complications. Once the wires have been broken, it is very difficult to remove the broken pieces of metal wires. We report a 50 years old male patient with broken tension band wires at multiple sites for patella fracture. The broken wires were removed 20 years after the initial surgery without any undue complications, however patient sustained significant soft tissue damage to remove all the pieces of broken wires that would otherwise have been removed without any undue complications immediately after fracture union.

Introduction: The optimal surgical treatment for acromioclavicular joint (ACJ) injuries remains controversial. The modified Weaver-Dunn (WD) procedure is one of the frequently used techniques. Recently when it was compared with anatomical autogenous tendon graft reconstruction procedures, the results were inferior. However, these anatomical procedures are technically more demanding with small margin of error and they have tendency for postoperative pain because of extra donor site incision.Materials and Methods: Forty patients with type IV to VI ACJ dislocations were treated by modified WD procedure using non-absorbable synthetic suture passed through the base of coracoid process for augmentation of transferred coraco-acromial (CA) ligament. Functional outcome was assessed using the Oxford Shoulder Score, Nottingham Clavicular Score and Visual Analog Score (VAS) at the final follow-up after surgery.Results: The mean pre-operative Oxford Shoulder Score improved from 25.22±2.64 (range 20 to 30) to 44.75±1.99 (range 40 to 48) and mean pre-operative Nottingham Shoulder Score improved from 49.25±4.91 (range 39 to 58) to 87.27±4.39 (range 79 to 96) at last follow-up after surgery with p-value <0.001. Thirty-five (87.5%) patients had excellent outcomes, four (10%) patients had good outcomes and one (2.5%) patient had fair outcome. Thirty-eight (95%) patients had no pain while two (5%) had moderate pain based on VAS score.Conclusion: Modified Weaver-Dunn is a simple well established technique for grade IV to VI ACJ dislocation. We cannot consider this procedure as old and outdated on the argument that the long term functional outcomes are not suboptimal.

Introduction: Blood loss associated with spine fusion surgery is a common potential cause of morbidity and often requires a blood transfusion, which subjects patients to risks of blood transfusion. Tranexamic acid is used intra-operatively to reduce bleeding in major surgeries. This study aims to evaluate its efficacy on perioperative blood loss and transfusion requirement in patients undergoing spine fusion surgery Methods: This prospective randomised controlled study was conducted at Department of Orthopedics of Tribhuvan University Teaching Hospital between August 2015 and July 2016. Patients undergoing spine fusion surgery were randomly assigned to group A (TXA) and group B (control) equally, thirty patients in each group. TXA was given to group A in a loading dose of 10 mg/kg, followed by continuous infusion of 1 mg/kg/hr during surgery. Outcome measures included perioperative blood loss, amount of blood transfusion, and safety and adverse effects. The data were analyzed by means of SPSS version 21.0. The results were presented as mean ± SD. Differences were considered significant if the P-value was <0.05. Results: Sixty patients (31 males, 29 females) with mean age of 39.95 years were enrolled in study, thirty patients in each group. Statistical analysis showed no significant differences between the 2 study groups with regard to age, sex, weight, preoperative hemoglobin, level of fusion as well as operative time. The amount of perioperative blood loss was significantly less in the group A versus group B, 241.274±162.819 ml vs 661.053±189.469 ml, p=0.000. There was no difference in the incidence of allogenic blood transfusion. There were no complications related to use of TXA in this study. Conclusion: TXA provided an effective and safe method for reduction of blood loss during and after spine fusion surgery. However, there was no difference in the incidence of perioperative allogeneic blood transfusion.

Background The treatment of displaced base of fifth metatarsal fracture remains controversial regarding the conservative and operative treatment. Objective To investigate the therapeutic effect of operative and non-operative treatment for base of fifth metatarsal fractures. Method This was retrospective comparative study performed in Civil Service Hospital, Kathmandu, Nepal from December 2014 to November 2019. Patients were randomly divided into two groups by computer generated technique. Group1 included 17 patients who underwent open reduction and internal fixation using tension band wiring, whereas group 2 included 17 patients who underwent non-operative treatment with boot cast. Result The AOFAS and VAS-FA scores at 3 months in operative and non-operative groups were 89.34±2.14 versus 86.94±2.22 (p < 0.05) and 5.58±0.87 versus 3.58±0.93 (p < 0.05). Similarly, AOFAS and VAS-FA at 12 months after treatment were 90.94±2.43 versus 90.17±1.55 (p > 0.05) and 0.64±0.280.94±0.39 (p > 0.05) in operative and non-operative groups respectively. The average time to bear full weight and return to work were 6.82±1.13 versus 7.08±1.24 weeks (p > 0.05) and 8.76±1.20 versus 10.35±1.41 weeks ( p < 0.05) respectively. The mean of VAS score at 3months of treatment is 5.58±0.87 for non-operative group and 3.58±0.93 for operative group (p <0.05). Conclusion Operative intervention has been preferred over the non-operative treatment in young adults or athletes with more than 3 mm displaced fifth metatarsal base fracture to achieve anatomical reduction of fracture, hasten the recovery and rehabilitation and to decrease the complications associated with non-operative treatment.