Introduction: The management of distal tibia fracture is challenging because of the limited soft tissue coverage and poor vascularity around the bone in that area. Minimally invasive percutaneous plate osteosynthesis is a novel technique in this regard but needs fluoroscopy. In unavailability of fluoroscopy or its technical malfunction, limited open reduction percutaneous plate osteosynthesis becomes useful. The aim of this study is to compare the outcomes of distal tibia fractures treated by LORPPO and MIPPO techniques in terms of duration of hospital stay, full weight bearing, union time and complications. Methods: Twenty-two cases of closed distal tibia fractures without articular involvement or comminution operated at Koshi Zonal Hospital, Nepal from March 2014 to May 2016 were included in this study. Total 11cases of which were treated by MIPPO whereas other 11 cases were treated by LORPPO. MIPPO technique was done only when the fluoroscopy was available. Results: In MIPPO, the average age of the patients were 43.72 (range 23-65) years, hospital stay mean duration 8.45 (range 6-12) days, full weight-bearing walking was started in 11.27 (range 9-15) weeks and average radiological union time was 21.25 (range 18-28) weeks. In LORPPO, the mean age was 46.36 (range 25-70)years, hospital stay mean 11.81 (range 10-15) days, full weight bearing walking mean 10.63 (range 9-15) weeks and average radiological union time was 23.0 (range 19-27) weeks. Conclusions: The outcomes are comparatively similar for both the techniques. LORPPO could be an alternative to MIPPO in the management of distal tibia fractures. Keywords:  distal tibia fracture; limited open reduction; percutaneous plate osteosynthesis.

Introduction: Cataract is the main cause of bilateral blindness in Nepal. Surgery is the accepted treatment option for cataract with Small incision Cataract Surgery (SICS) and Phacoemusification being the common procedures being performed with comparable results. Corneal astigmatism has been a byproduct of cataract surgery since the first limbal incision was made with improved techniques. Self-sealing scleral pocket incisions are stable and provides early healing, faster visual restoration and more importantly superior astigmatism control. A variety of scleral incisions are being used in manual SICS, with the aim of keeping the post-operative astigmatism to a minimum. Despite having many techniques of scleral incision, there have been only few studies which compares surgical induced astigmatism (SIA) between them Objective: To determine surgical induced astigmatism following frown, chevron and straight incision forms in suture-less small incision cataract surgery(SICS). Methodology: A prospective study was done on a total of 120 patients aged 40years and above with senile cataract. The patients were randomly divided into three groups where each group received specific incision- Straight, Frown and Chevron. SICS with intraocular lens (IOL) implantation was performed. The patients were compared on 2 weeks and 6 weeks post operatively for uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA) and keratometric reading. Surgical induced astigmatism (SIA) was calculated using the SIA calculator version 2.0. The study was analysed using SPSS version 20.0. Results: At 6 weeks UCVA of 6/18-6/6 was attained by 63.41%, 78.94% and 84.61% of patients in group straight, frown and chevron. However about 97% of patients attained BCVA of 6/18-6/6 in all three groups. Mean SIA was least in Chevron group (0.30 D ± 0.16) and was most in the straight group (1.22 D ±0.36) which was statistically significant. Conclusion: Chevron incision induces the least astigmatism compared to frown and straight incision.

Introduction: Idiopathic frozen shoulder (IFS) is a common chronic and disabling condition of shoulder pain characterized by progressive loss of active and passive range of motion (ROM) with unclear pathogenesis. The ideal treatment protocol is still controversial but commonly used treatment includes single agent or combination of oral non-steroid anti- inflammatory drugs (NSAIDS), oral steroids, intra-articular steroid injection and physiotherapy. Objective: The objective of this study was to evaluate the effectiveness of intra-articular methylprednisolone injection for pain and ROM in patients suffering from idiopathic frozen shoulder who did not respond to oral NSAIDS with or without oral steroid. Methodology: A total of 70 patients suffering from IFS were enrolled in this cross sectional study from May 2017–October 2018 from outpatient department of orthopaedic and physiotherapy of Koshi Zonal Hospital. All the patients underwent treatment protocol that comprised of Intra-articular steroid injection followed by five days of oral NSAIDS along with five days regime of physical therapy at the physiotherapy centre, followed by home exercise program. Each patient was followed up at every two weeks interval from intra-articular injection till 6th week. Each patient was evaluated for range of motion (ROM), Numerical Pain Rating Scale (NPRS) and Shoulder Pain and Disability Index (SPADI) before the treatment protocol and at every follow up visit. Data was analyzed using Microsoft Excel Program. Results: All patients enrolled for the study had satisfactory response. The mean age of the patient was 51.8 years (range 40-65 years). The mean age of the 26 male patients was 54 years (range 45-65), whereas the mean age of 44 female patients was 50.5 years (range 45-60). Mean duration of illness was 26.5 weeks (range 18-32 weeks), SPADI before medication was 83.14, at 2nd week was 50.92, at 4th week was 38.63 and at 6th week was 27.22. Conclusion: Combination of intra-articular methylprednisolone injection, physiotherapy and home exercise program is effective in IFS for rapid improvement in pain and ROM.

Introduction: Animal bite is a common public health problem and dog bites are most common among them in Nepal. Rabies infection is of most significant concern following animal-bites’ injuries. This study aimed to assess the epidemiological variation in terms of demographic variables, type of animal, circumstances of bite, type and site of wound and outcome of the animal bite. Methods: It was a descriptive cross-sectional study conducted at emergency department of Gandaki Medical College Teaching Hospital and Research Centre among animal-bite cases from October 1, 2020 to September 30, 2021 using a pre-designed questionnaire. Results: Out of total 217 cases of animal-bite included in the study, 65 (29.95%) were of 21 to 30 years and 129 (59.46%) were males, 120 (55.23%) cases hailed from rural area and 63 (29.03%) were farmers. Most cases 168 (77.42%) were bitten by dog among which 93 (55.35%) were owned dogs and only 22 dogs were vaccinated. A total of 127 (58.53%) were unprovoked and lower limb 130 (59.91%) was the commonest site. World Health Organization (WHO) Category II wound were the most commonly encountered 122 (56.22%). Majority 99 (45.62%) came to hospital within 25 to 48 hours of bite and after cleaning the wound site 115 (52.99%). Only 81 (37.78%) animals were observed for 10 days after the bite out of which 5 (6.09%) developed signs of rabies. Conclusions: Animal bite was common in males and source was owned dogs. Majority of the owned dogs were not vaccinated and most of the cases visited hospital without following first-aid measures.

Introduction: Glaucoma is one of the common causes of blindness worldwide, and the leading cause of irreversible blindness .The overall prevalence of glaucoma in Nepal is 1.9%. Though poorly understood, primary open angle glaucoma (POAG) is believed to have a genetic or familial component that may occur through polygenic or multifactorial transmission. First-degree relatives of POAG patients have 4–16% risk of developing POAG. Given the circumstances and the prevalence of POAG in first degree relatives of POAG patients, screening the first degree relative/s accompanying the patient to the hospital can be a cost effective and viable tool for glaucoma screening that will not add any extra cost of travel and accommodation. Materials and methods: The authors performed a hospital-based cross-sectional study at a tertiary eye hospital in Nepal. All first-degree family members of POAG patients who accompanied them to the glaucoma clinic underwent a full ophthalmic examination.The optic disc was evaluated and intraocular pressure (IOP) was measured. POAG and glaucoma suspect were defined as per ISGEO classification. Results: Sixty one first degree relatives of 54 glaucoma patients were examined. The mean age was 30.67 years (±12.71). Fifty five(90.2%) of 61 of accompanying first degree relatives were off springs, 6 (9.8%) were siblings. Five out of 61 (8.2%) were diagnosed as glaucoma and started on anti-glaucoma medication. Fourteen participants (23%) were glaucoma suspects. Forty two (68.9%) of the participants had no sign of glaucoma. Conclusion: Ocular examination of the first-degree relatives accompanying POAG patients helped to identify a remarkable number of individuals with glaucoma and thus might be used as an effective and viable tool for screening glaucoma in a hospital setting. Awareness regarding glaucoma is very low even among the first degree relatives of glaucoma patients.