Introduction: Injury is a major cause of morbidity and mortality globally with the majority of them being orthopaedic in nature and are the resultants of fall, road traffic accidents (RTA), physical assault amongst others. The aim of this study was to determine the patterns of musculoskeletal injury among orthopaedic inpatients in a tertiary care teaching hospital in Nepal. Methods: It was a cross-sectional study conducted in the department of orthopaedic surgery at College of Medical Sciences and Teaching Hospital (COMS-TH), Bharatpur from January to December 2019. Patients presenting with orthopaedic injury and admitted and treated as inpatients were assessed for their demographic details, mode of injury and other patterns of injury and descriptive analysis was done. Results: In a total of 1027 patients, the mean age was 33.4 years (range: 1.0 - 95.0). Most of them (74.5%) were male. Right side was the most predominant side of injury (53.8%). Students were most commonly affected groups (34.8%). RTA was the most common mode of injury (66.9%). The commonest pattern of injury was fracture (70.1%). Closed bony injuries were sustained by 74.1%. Head injury was the most commonly associated injury. Conclusions: The commonest mode of injury was RTA. Closed fracture was the most common type of fracture. Extremity injury was the most common site and head injury was the commonest associated injury. These patterns can serve as valuable tools in clinical decision making and further research studies.

Background: Length of Hospital Stay (LOHS) can have important effects on the cost of treatment and patient outcomes. The aim of this study was to determine the length of hospital stay among orthopaedic inpatients and assess its association with different socio-demographic and clinical factors. Methods: A retrospective study was conducted at College of Medical Sciences and Teaching Hospital, Nepal, wherein, clinical records of patients admitted and treated as inpatients between January and December 2019 were retrieved. Demographic data, diagnosis, treatment details, LOHS, co-morbidities, treatment modality and mode of payment were documented and data was analyzed using SPSS software 16.0. Median was calculated for skewed continuous data and frequency analysis was done for categorical variables. P value <0.05 was considered statistically significant. Results: In a total of 1248 patients with mean age of 33.8±18.7 years, 72.4 % (n=904) were male. Most of them (34.9%, n=435) were students and majority (62.5%, n=780) were from outside Chitwan. The median LOHS was 5.0 (3.0–10.0) days. It was significantly greater in cases from outside Chitwan, those with trauma, infection, associated injury, and complications (p<0.05). Moreover, there was significant difference in LOHS among various age quintiles, occupations, fracture types, modes of payment and treatment modalities (p<0.05). However, LOHS did not differ significantly between patients with or without co-morbidity and gender (p>0.05). Conclusions: This study identified that the LOHS was significantly associated with various clinico demographic factors except gender and co-morbidity. More studies can be conducted to assess the relationships further.

Background: As documented in many studies, anterior shoulder dislocation can be effectively immobilized in both external and internal rotation positions, with favorable outcomes. However, controversy exists about the superiority of the technique of immobilization to achieve the reduced rate of redislocation. We conducted this study to assess the functional outcome of immobilization of shoulder in external rotation position after relocation in patients with acute anterior shoulder dislocation. Methods: This is hospital based cross-sectional study in total of 36 patients of primary anterior dislocation of shoulder. They were managed with closed reduction and immobilization in external rotation position and followed up for up to twelve months. Functional outcome (including re-dislocation rate) during each follow-up visit was assessed by using ROWE Score. Results: The mean age of the participants was 29.6±7.9 years (range: 17-44 years). Of them, 89.9% were male; and 55.6% were involved in risky jobs. Similarly, 50% of them sustained injury due to slip and fall, 72.2% presented to the hospital within 12 hours; and 69.4% had their right side involved. All the patients were compliant with treatment regime; 77.8% tolerated the brace well and the redislocation rate was 8.3%. ROWE score was found to be significantly increased between subsequent follow-up visits (p<0.05), except between six months and 12 months (p>0.05). Overall, ROWE score varied significantly across the total follow-up period (p<0.05). Conclusions: Immobilization in external rotation position in traumatic anterior shoulder dislocation was a simple and easy method of conservative treatment with good patient compliance, less incidence of re-dislocation and good functional outcome.

Background: Distal radius fracture is the most common fracture of upper extremity. There are wide variety of treatment options including plaster, ligamentotaxis, percutaneous pinning and plating for the treatment of displaced distal end radius fracture in the adult. Each option has got its own pros and cons. This study was designed with an objective of assessment of functional and radiological outcome of displaced distal end radius fracture treated with volar locking plate. Methods: This was a retrospective study of closed displaced fracture of distal end radius managed with volar locking plate from January 2018 to September 2020. Data were collected from the case chart and included patient’s demography, fracture characteristics, radiological parameters, range of motion and complications. Data analysis was done using Statistical package for social science 20.0 software. Descriptive statistics for categorical variable was used and mean of the continuous data was compared using student’s t-test.   P-value <0.05 was considered as statistically significant. Results: The mean age of patient was 35.87 years after analysis of total of 30 patients with mean follow up of 12.87 months. Road traffic accident (76.7%) was the most common mode of injury. There were 36.7% Association of Osteosynthesis (AO) type B and C injuries, each. The mean Quick Disabilities of Arm, Shoulder and Hand (DASH) score was 1.13 (range 0 - 6.81) at the final follow up. The mean union time of the fracture was 6.6 weeks. One patient had stiffness and one developed reflex sympathetic dystrophy. Conclusions: Functional and radiological outcome of the displaced distal end radius in adult treated with open reduction and internal fixation with locking plate was found good to excellent in most of the cases.