Introduction: Acromioclavicular joint dislocation Type III is still controversial for its management, despite of numerous trials and reviews. Aims: To compare and evaluate the functional and surgical outcome of Rockwood Type III acromioclavicular joint dislocation treated surgically with clavicular Hook plate and Tension Band wiring with K-wires. Methods: In a prospective hospital based interventional study comprising of total 22 patients with a mean age of 31.36 ± 7.53 years who presented with Rockwood Type III acromioclavicular joint dislocation were carried between January 2018 to December 2019. They were graded according to Rockwood et al. classification. All 22 patients underwent open reduction and internal fixation. These patients were divided into two groups according to operative procedure; of which 11 patients were treated with clavicular hook plate (CHP) and rest 11 were treated with tension band wiring with K-wires (TBW).  Descriptive comparison was tabulated during pre-operative, intra-operative and post-operative periods. The Constant-Murley Shoulder scoring system was applied for evaluating the results.  Results: The mean follow up period was 7.6 months. The clavicular hook plate  was removed at 10 months in one patient due to severe pain and limited range of motion , and removal of Tension Band wiring with K-wires were done in two patients due to wound dehiscence and Kirschner wire back out at 5 and 6 months. The mean Constant- Murley shoulder score was 82.6 (min. 70 & max. 93) in clavicular hook plate and 74.72 (min 68 & max. 84) in Tension band wiring with K-wires which found to be significantly difference in mean scoring between two groups.  Conclusion: Patients treated with Clavicular Hook Plate for Rockwood Type III acromioclavicular joint dislocation had a very good functional and surgical outcome over Tension Band wiring with K-wires.

ABSTRACT:Introduction: Tibia fractures in the skeletally immature patient can usually be treated with above knee cast or patellar tendon bearing cast. The purpose of our study was to evaluate epidemiology and outcome of Elastic stable intramedullary nailing fixation of pediatric tibial shaft fractures treated at our institution. Methods: Over a period of one year, fifty pediatric patients of tibial shaft fractures, with average age of 9.68 yr (SD=2.37), were treated with elastic stable intramedullary nail. Demographic data, union and complication rate were evaluated. Results: There were 36 closed and 14 open fractures. The average time to union was 11.6 weeks (SD=2.65) for close and 14.3 weeks (SD=2.62) for open fracture. There were no instances of growth arrest, re-manipulations, or re-fracture. Conclusion: We conclude that flexible intramedullary fixation is an easy and effective method of management of both open and closed unstable fractures of the tibia in children.

Introduction: Proximal humeral fracture accounts for four to five percentage of all fractures. Undisplaced fractures can be managed conservatively however, for displaced fractures; no particular method is a panacea. In our study we treated displaced proximal humeral fracture with Joshi’s external stabilizing system. Aims: To evaluate functional outcome of displaced proximal humerus fractures managed byJoshi’s external stabilizing system. Methods: This prospective study includedall patients with displaced proximal humerus fracture (Neer’s type two and three); treated with JESS from August 2018 to August 2021at Nepalgunj Medical College, Kohalupurand functional outcome was evaluated using Neer’s criteria at final follow-up. Ethical clearance was obtained from Institutional Review Committee. Results: A total of 40 patients, 23 males and 17 females with mean age of 41.2 years (range from 18 to 60) were included. Mean follow-up duration was 24 ± 1.7 weeks.  All fractures united at an average of 13 ± 1.7 weeks. Twenty-nine patients (72.5%) had an excellent result with average score of 92.7 ± 2.3 and remaining 11(27.5%) had satisfactory functional outcome with average score of 84.7 ± 1.7 according to Neer’s criteria. Three patients had bicipital tendonitis that resolved within eight weeks of implant removal while two had pin tract infection which resolved with oral antibiotics and dressing. Conclusion: Joshi’s external stabilizing system is an effective treatment option in patients with displaced proximal humeral fractures.

Background: Clavicular fracture is a common traumatic condition encountered around shoulder region in adult population, while mid-shaft fractures (Robinson’s type 2) are found to be a most common variety. Management trends have changed in recent years from conservative to surgery, considering the higher rates of malunion, nonunion and poorer functional outcomes when managed non-operatively. An open reduction and internal fixation with precontoured locking compression plates has been a backbone of treatment of these fractures for several years with the aim of anatomical reduction, stable fixation and early rehabilitation of affected shoulder. Objective: To evaluate the outcome of Robinson type 2 clavicular fractures managed surgically with precontoured locking compression plates. Methods: Prospective study of 100 adult patients with Robinson type 2 clavicular fractures managed surgically with precontoured locking compression plates from January 2017 to November 2019 at the department of orthopaedics of Nepalgunj Medical College, Kohalpur. Outcomes were evaluated radiologically as well as functionally on the basis of Constant and Murley’s scoring system. Result: Union was achieved in 98% patients with an average duration of 4.16 months with standard deviation of 1.23. Functional results were excellent in 80% and good in 17%. There were two major complications, one requiring reoperation and hardware removal due to deep infection while other went into nonunion. One patient sustained re-fracture within 2 weeks following implant removal after another trauma. Conclusion: Outcome of surgery was satisfactory with desirable result in almost all of the patients. The surgery was simple, easy to perform and was free from radiation exposure.

Introduction: Medial malleolus fracture is one of the commonest fractures. Non-operative approach may fail to produce anatomical reduction leading to ankle instability, nonunion and post traumatic osteoarthritis of the ankle. Proper anatomical reduction and stable internal fixation remains the key in treatment of displaced fracture. Good result had been achieved with Modified Tension Band Wiring. Aims:The purpose of our study was to evaluate the functional outcome of medial malleolus fracture treated with modified tension band wiring. Methods:This prospective observational study was conducted in department of Orthopaedics of Nepalgunj Medical College and Teaching Hospital from September 2018 to August 2021. Patients were evaluated for mode of injury, type of fracture, associated injury, radiological union, functional outcome, accompanying complications. All of the medial malleolus fractures in this study were treated by modified tension band wiring and outcomes were evaluated using Olerud and Molander Score. Results: In this study of 40 patients with the mean age of 41.60+13.75 year, 31(77.5%) were male and 9 (22.5%) were female. Majority of fractures were observed between 35 to 44 years, right side was predominantly involved, road traffic accident was the most common mode of injury. The average time duration of surgery from the time of injury was 5.25 days. Final functional outcome as per Olerud and Molander score showed, seven (17.5%) patients had excellent results, 30 (75%) patients had good results and three (7.5%) patients had poor results. The most common complication noted was hardware prominence at 7.5%, followed by superficial wound infection in 5% of patients. Conclusion: Modified Tension band wiring of medial malleolus results in good to excellent outcome in most of the patients with few complications .