Background: Clavicle fracture is one of the common fractures accounting for 2.6-12% of all fractures and 44-66% of shoulder fractures with midclavicle fracture accounting for 80% of clavicle fractures. Most of the clavicles were treated conservatively in past but recently there has been an increasing tendency for operative management of clavicle fractures. With studies done showing varying results it is not clear whether primary surgical management provides any better results than conservative management. So, this study was carried out to compare the radiological and functional outcome following conservative management to that of operative management with plating for displaced midshaft clavicle fractures.Methods: In a single center, prospective clinical trial, 60 patients with displaced midshaft fracture of the clavicle were systematically randomized (alternate patient) into either operative treatment with plate fixation or nonoperative treatment with clavicle brace and sling. Outcome was analysed in terms of functional outcome and radiological union by standard follow-up, Constant and Murley shoulder score and plain radiographs. All sixty patients completed sixmonth follow up and there was no difference between two groups with respect to patient demographics, mechanism of injury and fracture pattern.Result: There was no significant difference in Constant shoulder score between the two groups. The mean time of union was 14.57 weeks in operative group compared to 16.04 weeks in nonoperative group (p value=0.191). There were two nonunion in nonoperative group compared to none in operative group. The complications in operative group were mainly hardware related (four had loosening of screw, two had implant failure and one had infection). At six months after surgery patient were more likely to be satisfied with the results in operative group compared to nonoperative group (p=0.02). Conclusion:Six months after a displaced midshaft clavicular fracture, nonoperative treatment resulted in higher malunion and nonunion rate but similar functional outcome and union time compared to operative management. However, patients were more likely to be satisfied in operative group compared to nonoperative group.

Introduction:Traumaticperipheralvascularinjuryremainsasignificantcauseofmorbidityandmortalityamongthegeneralpopula- tion. Majority of peripheral arterial injury are caused by a blunt trauma with a concomitant soft tissue injury and fractures requiring multidisciplinaryapproach.Despitemajoreffortsinestablishingprotocolsandguidelines,optimalstrategiesoftraumaticperipheral vascular injury are still under investigation and may vary depending upon the local setup and expertise available. The aim of this study was to identify the epidemiological profile of traumatic peripheral vascular injury presenting at tertiary care center of Nepal. Method: This is a retrospective study of patients who underwent vascular surgery in College of Medical Sciences Bharat- pur, from December 2018 and July 2021. Ethical approval was taken from the Institutional Review Committee of College of Medical Sciences (Registration Number 2020-081). Data for the study was retrieved from Emergency records, oper- ation records and medical record department of the hospital. A total of 63 cases of all age and sex were included in the study. Only patients having traumatic peripheral arterial injury and undergoing surgical intervention were included in the study. Patient data was initially tabulated using Microsoft Excel and analysis was done in SPSS software version 22.0. Result:Traumatic peripheral arterial injury was most commonly seen in 21-30 years (36.5%) age group with male preponderance (88.9%).Sharpinjurymechanismaccountedfor(42.9%),followedbyroadtrafficaccidents(41.3%).Upperlimbarterialinjurywasseenin 61.9% of patients and radial artery was the most common to be injured (34.9%). Associated tendon injury was seen in 63.5%, whereas nerveinjurywasseenin20.6%.Complicationswereseenin47.6%patientsandwoundinfectionwasthemostcommonailment(12.7%). Conclusion:Traumatic peripheral vascular injury has a male preponderance with road traffic incidents being the major mechanism of injury in Nepal. These injuries have a high rate of complications.

Introduction: Human-wildlife conflict in the Himalayan kingdom of Nepal is the major concern in and around the protected area due to dramatic change in the ecosystem which includes a rise in human population and their basic requirements that leads to loss of natural habitat for agriculture farming and residential purpose. On the other hand, successful conservation programme in some protective areas leads to a rise in a number of wildlife. This conflict ultimately leads to damage of the crops, property, livestock and the most important human casualties which is the main focus of this study.Methods: This is a hospital-based retrospective study in which 32 patients visiting the emergency and outpatient department with a history of wild animals attack were included. Advanced trauma life support protocol for polytrauma patients was followed. Anti tetanus and anti-rabies prophylaxis given followed by antibiotics coverage. Operative and multidisciplinary interventions were made as per the requirement.Results: Out of the total 32 patients, soft tissue injury Oestern-Tscherne grade 3 was the commonest type of injury seen in 19(59.4%) of the cases, the commonest species involved was rhinoceros 8(25%). The anatomical site most commonly involved was lower limb 10(31.3%). Fracture fixation was required in 8(25%) cases. The commonest complication was wound infection in 5(16%) cases.Conclusion: This research elaborates the current scenario of human-wildlife conflict, facilitates to identify and face the common type of injuries, their complications, the role of a multidisciplinary approach and hence implement certain treatment protocols as a part of effective management to avoid major consequences to public health.