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.

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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: Soft tissue defect around distal leg, ankle and heel region is a challenging task for an orthopaedic surgeon. Sural artery reverse fasciocutaenous flap has been widely used and is a successful method for soft tissue reconstruction in such situation. This study aimed to find out the result of sural artery distal based pedicle flap in managing soft tissue recon­struction around the ankle and distal leg. Methods: This was a retrospective study of 12 cases of sural artery based fasciocutaenous flap done between January 2015 to December 2019. Medical records were used to find the details of demographic data, operative details and post-operative status of the patients. Patients were contacted for the final follow up at minimum of 6 months after operation for assessment of the outcome. Demographic and clinical data were entered in excel chart and the clinical result was analyzed using SPSS software version 20.0. Results: There were total of 12 patients who underwent sural artery flap procedure. Among them, 10 were male and 2 females with mean age of 39 (range, 25-52) years. Eleven flaps survived with satisfactory functional outcome. One had complete flap necrosis, two had patchy margin necrosis and two had superficial infection which healed well with minor debridement and antibiotics. Conclusions: Sural artery based reverse fasciocutaenous flap is good and technically easier option for an orthopaedic surgeons for the soft tissue reconstruction around ankle, heel and distal leg in traumatic, infective or other etiology with satisfactory outcome in most of the patients.