de Quervain’s Disease among Patients Visiting the Orthopaedic Outpatient Department of Tertiary Care Center: A Descriptive Cross- sectional Study

Introduction: de Quervain’s disease is one of the common causes of wrist pain. It can cause serious disability and absence from work due to impaired functioning of the wrist and hand. The aim of this study is to find out the prevalence of de Quervain’s disease among patients visiting the orthopaedic outpatient department of a tertiary care centre. Methods: This was a descriptive cross-sectional study conducted among patients visiting the orthopaedic outpatient department of a tertiary care centre after receiving ethical approval (IRC KAHS Reference: 078/079/56). This study was conducted from 1 January 2021 to 30 December 2021 from hospital medical records. A convenience sampling method was used. Patients with de Quervain’s disease from 16 to 60 years were included in this study. Clinically diagnosis of de Quervain’s disease was based on the tenderness of the radial styloid process, tenderness over the first extensor compartment on resisted thumb abduction or extension and positive Finkelstein test. Point estimate and 95% Confidence Interval were calculated. Results: Out of 9600 orthopaedic outpatients, de Quervain’s disease was seen in 128 (1.33%) (2.68-4.52, 95% Confidence Interval). Conclusions: The prevalence of de Quervain’s disease was similar when compared to other studies conducted in similar settings

Functional outcomes of Total Hip Replacement using modified Harris Hip Score

Background: Total hip replacement (THR) is a common surgery for relieving pain and improving the quality of life in patients with moderate to severe hip arthritis. The primary reason for THR is severe hip osteoarthritis, when conservative measures fail to relieve pain. The objective of the study was to examine functional outcomes, indications, and complications of THR using mHHS at different stages. Methods: A prospective observational study was carried out at the Department of Orthopedics, National Trauma Center, NAMS, from September 2019 to December 2020. The study included first 35 hips of 35 patients who underwent Total Hip Replacement at our hospital and met the inclusion criteria. Follow-up assessments were conducted at 6 weeks, 3 months, and 6 months after the surgery. Each visit involved thorough clinical and radiological examinations, as well as documentation of the mHHS chart. All continuous variables were expressed as mean ± standard deviation and two sample t test was used to compare means of two sub groups. Results: The study enrolled participants aged 26 to 66, with 60% male and 40% female. Right sided involvement was observed in 55% of cases, while the left side was affected in 45%. The most common reason for surgery was osteoarthritis caused by avascular necrosis of the femoral head. The average preoperative mHHS was 28, which increased to 64 at six weeks, 86 at three months, and 92 at six months. The study found that 80% of participants achieved excellent results. Complications, including a 2.85% dislocation rate, were reported. Conclusion: THR is a safe and effective procedure, providing excellent functional outcomes and minimal complications when performed carefully and precisely. Long-term studies are needed to investigate late complications and further establish the efficacy of the implants and the procedure

Complication of Early Application of One and a Half Hip Spica for Femoral Shaft Fractures in Children below Six Years in a Tertiary Care Hospital: A Descriptive Cross-sectional Study

Introduction: Hip spica with or without prior traction has become a standard treatment for closed isolated femoral shaft fracture in children below six years. The time of hip spica application is not uniform in the existing literature. The aim of this study is to find out the prevalence of complication of early application of one and a half hip spica for femoral shaft fractures in children below six years in a tertiary care hospital. Methods: A descriptive cross-sectional study was done among 42 children who were managed with early hip spica application (within 72 hours) for femoral shaft fracture from January 2015 to December 2020 after receiving ethical clearance from Institutional Review Committee. Convenient sampling technique was done. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Complication was seen in nine (21.4%) (95% Confidence Interval= 9.02-33.84) patients. Skin breakdown from local pressure had the highest prevalence in our study which was documented in three (7.14%) patients who resolved with conservative treatment. Conclusions: The prevalence of complication of early application of one and a half hip spica for femoral shaft fractures in children below six years was similar to other studies done in similar setting. </jats:p

de Quervain’s Disease among Patients Visiting the Orthopaedic Outpatient Department of Tertiary Care Center: A Descriptive Cross- sectional Study

Introduction: de Quervain’s disease is one of the common causes of wrist pain. It can cause serious disability and absence from work due to impaired functioning of the wrist and hand. The aim of this study is to find out the prevalence of de Quervain’s disease among patients visiting the orthopaedic outpatient department of a tertiary care centre. Methods: This was a descriptive cross-sectional study conducted among patients visiting the orthopaedic outpatient department of a tertiary care centre after receiving ethical approval (IRC KAHS Reference: 078/079/56). This study was conducted from 1 January 2021 to 30 December 2021 from hospital medical records. A convenience sampling method was used. Patients with de Quervain’s disease from 16 to 60 years were included in this study. Clinically diagnosis of de Quervain’s disease was based on the tenderness of the radial styloid process, tenderness over the first extensor compartment on resisted thumb abduction or extension and positive Finkelstein test. Point estimate and 95% Confidence Interval were calculated. Results: Out of 9600 orthopaedic outpatients, de Quervain’s disease was seen in 128 (1.33%) (2.68-4.52, 95% Confidence Interval). Conclusions: The prevalence of de Quervain’s disease was similar when compared to other studies conducted in similar settings.</jats:p

Orthopaedics Practice in a Rural Hospital During the COVID-19 Pandemic: A Descriptive Cross-Sectional Study

Introduction: The coronavirus disease 2019  pandemic is one of the biggest public health challenges that we have faced, and has had a significant impact on the delivery of essential healthcare worldwide. Trauma and orthopaedic surgery was one of the most severely affected specialties as all non-emergency surgical cases were cancelled. With the possibility of future peak of corona virus, knowing the impact of Covid on orthopaedics would enable us to manage trauma patient in an effective manner and will help us to resume normal schedule of the trauma care. Methods: This is a descriptive cross-sectional study. We studied the details of total number of patient at Orthopaedic and trauma outpatient, inpatient and operation theatre of Karnali Academy of Health Sciences from 14th March 2020 to 16 September 2020 as compared with the patient data from the same time period in 2019. Results: There were 2288 patients during the non-Covid period who visited to the orthopaedic outpatient in comparison to 1618 during Covid period. Only 5 implant removals were performed in comparison to 50 removals (90% reduction) in elective cases. But the number of surgical cases was almost similar (204 vs 207 respectively). Total number of hospital stay had significantly reduced in the non-COVID period (average 4 days vs 6 days).  Conclusions: There is reduction in number of orthopaedic and trauma cases during COVID 19 with marked reduction in number of elective cases. Alternative methods of treatment like telemedicine and small scale health camps at peripheral districts should be conducted to treat non-urgent orthopaedic conditions during lockdown

Functional Outcome of Minimally Invasive Percutaneous Plate Osteosynthesis in Distal Tibial Fracture

Background: Traditional plating techniques for distal tibia fractures may produce periosteal stripping and microcirculatory damage, which may frequently induce infection, nonunion or both. Treatment of these injuries using minimal invasive percutaneous plate osteosynthesis (MIPPO) technique may minimize soft tissue injury and damage to the vascular integrity of the fracture fragments. The objective of our study was to assess the clinical result of MIPPO for distal fracture of tibia. Methods: A total of 30 patients of distal tibia fracture treated with MIPPO with Locking compression plate (LCP) Technique at National Trauma Center, Kathmandu were studied during a period of one year. Patients were followed up on 2nd post-operative week and then at an interval of 4 week till 6 months. Tenny and Weiss clinical assessment criteria was used in each follow up. Results: In our study, mean age of the patients was 36.9 year with standard deviation ± 9.4 and majority of them were male (60%). The mean time for radiological union of bone was 17 weeks. In final follow up, 2 cases had excellent result, 23 cases had good result and 5 cases had fair results. No case had poor functional outcome. Conclusion: MIPPO offers a reliable and reproducible technique for treating distal tibia fractures with intra-articular or peri-articular fracture extension. This technique avoids significant complications compared to more commonly used internal and external fixation techniques for such injuries. This procedure is associated with good functional outcomes regarding the ankle range of motion

Orthopaedics Practice in a Rural Hospital During the COVID-19 Pandemic: A Descriptive Cross-Sectional Study

Introduction: The coronavirus disease 2019 pandemic is one of the biggest public health challenges that we have faced, and has had a significant impact on the delivery of essential healthcare worldwide. Trauma and orthopaedic surgery was one of the most severely affected specialties as all non-emergency surgical cases were cancelled. With the possibility of future peak of corona virus, knowing the impact of Covid on orthopaedics would enable us to manage trauma patient in an effective manner and will help us to resume normal schedule of the trauma care.&#x0D; Methods: This is a descriptive cross-sectional study. We studied the details of total number of patient at Orthopaedic and trauma outpatient, inpatient and operation theatre of Karnali Academy of Health Sciences from 14th March 2020 to 16 September 2020 as compared with the patient data from the same time period in 2019.&#x0D; Results: There were 2288 patients during the non-Covid period who visited to the orthopaedic outpatient in comparison to 1618 during Covid period. Only 5 implant removals were performed in comparison to 50 removals (90% reduction) in elective cases. But the number of surgical cases was almost similar (204 vs 207 respectively). Total number of hospital stay had significantly reduced in the non-COVID period (average 4 days vs 6 days). &#x0D; Conclusions: There is reduction in number of orthopaedic and trauma cases during COVID 19 with marked reduction in number of elective cases. Alternative methods of treatment like telemedicine and small scale health camps at peripheral districts should be conducted to treat non-urgent orthopaedic conditions during lockdown.&#x0D; </jats:p