External rotation method for reduction of acute anterior dislocation of shoulder

Introductions: Many different techniques of reduction of acute anterior shoulder dislocation have been described. The aim of this study was to evaluate the effectiveness of external rotation method for reduction of acute anterior shoulder dislocation. Methods: Fifty-one patients with acute anterior shoulder dislocations with or without greater tuberosity fracture were reduced during a period from January 2013 to January 2015. The external rotation method was used as an initial reduction method performed by orthopaedic surgeon on call or residents. Data sheets completed by the orthopaedic surgeon on call or residents were evaluated with regard to the type of dislocation, the effectiveness of the procedure in achieving reduction, the need for premedication, the ease of performing the reduction, and complications, if any. Results: There were 42 male and nine female patients between 18 to 78 years. Among 51 patients, 49 had successful reduction. No premedication was required in 33 patients who had a successful reduction, and the average time required for reduction in 23 patients was within two minutes whereas 20 patients reduced within five minutes. Only four patients reported severe pain during the process of reduction. The method was not successful in two patients with subcoracoid dislocation associated with displaced fracture of the greater tuberosity. Conclusions: External rotation method is reliable, safe, simple and relatively painless method for reduction of acute anterior shoulder dislocation. Keywords: acute anterior shoulder dislocation, external rotation method, painless reductionÂ

Outcome of tibial diaphyseal fracture fixation with Surgical Implant Generation Network (SIGN) nail

Introductions: Fractures of diaphyseal region of the tibial bone are amongst the most commonly seen extremity injuries in the developing countries. The surgical implant generation network (SIGN) intramedullary (IM) nail was designed for the treatment of long bone fractures in the developing nations. Methods: From March 2008 to December 2018, a total of 104 patients with 104 tibial diaphyseal fractures were treated with SIGN IM nail. The followup visits were arranged at 6, 12, 24 weeks and one-year post operatively. During followup visits, the signs of fracture union clinically as well as radiologically and the presence of complications any were recorded and analyzed. Results: The mean age of the patients was 32.81 (16 – 65) years, male 74 (71.2%) and  female 30 (28.8%). Majority of the patients 70 (67.3%) had fractures after road traffic accidents. The mean time of surgery was 13.58 (1 – 463) days. Six (5.8%) patients had delayed union and no non-union was detected. We had 10 cases (9.6%) of mal-alignment but were on acceptable range. Conclusions: In the developing country like Nepal, the SIGN nail is an effective surgical implant for the management of the tibial diaphyseal fractures with good result of fracture union and low rates of nonunion, mal-alignment and manageable complications. Keywords: diaphyseal fracture, intramedullary nailing, SIGN nail, tibial fractur

Three lateral divergent pinning for displaced supracondylar humerus fractures in children

Introductions: Cross or two lateral pinnings are the most commonly doneprocedures for displaced supracondylar humerus fractures in children. Acrossed pin is biomechanically stable than lateral pins, but associated withrisk of iatrogenic ulnar nerve injury. Recent studies have shown stable fixationwith three lateral pin construct. The purpose of this study was to evaluate theefficacy of three lateral divergent pinning for displaced supracondylar humerusfractures.Methods: Thirty five children with Gartland types III were treated betweenNovember 2012 and November 2013. Closed reduction and three lateraldivergent pinning was done with image intensifier guidance. Patients werefollowed up for minimum 6 months. Radiological assessment was done to seeunion, proper pin placement and loss of reduction. Clinically, patients wereassessed by using Flynn criteria.Results: There were 24 (68.6%) male and 11 (31.4%) female children between2 to 13 years of age with displaced supracondylar fractures, left side 26 (74.3%) and right nine (25.7%) cases. All were successfully managed with closed reduction and three lateral divergent pins within 2-6 days of injury. One radial and one median nerve palsies sustained at injury recovered spontaneously. No iatrogenic nerve injuries occurred. A comparison of perioperative and final radiographs revealed no loss of reduction. Twenty-seven excellent, five good, two fair and one poor results on Flynn’s grading. One patient had a superficial pin-tract infection.Conclusions: Closed reduction with three lateral divergent pins is safe for stablefixation of displaced supracondylar humeral fractures in children.Keywords: children, humerus, percutaneous pinning, supracondylar fractur

Evidence-based practice at Patan Academy of Health Sciences, Nepal: knowledge, attitude, behavior and barriers

Introduction: Evidence based practice (EBP) is the use of current best evidence in making decisions about the care of individual patients. The aim of this study was to explore the practices, attitudes, knowledge and perceived barriers in relation to EBP among faculty members at Patan Academy of Health Sciences (PAHS), Nepal. Methods: This was a cross-sectional survey study. Participants were faculty members (both clinical and non-clinical) at PAHS. The main outcomes were attitude towards the usefulness of EBP, the frequency of use of EBP in practice, and the barriers to carrying out EBP. Results: One hundred and seventy-two faculty members participated in this survey. Ninety five percent knew it was used for clinical decision making and the majority used it for teaching. Senior faculty spent more time on searching for evidence and reading compared to junior faculty. There was no difference between clinical and non-clinical departments. The main barriers to EBP were inadequate teaching learning support by 49% (85/172) followed by inadequate time 30% (52/172). Conclusions: The study showed that faculty at PAHS had a generally positive attitude towards EBP. EBP could be better facilitated by proper teaching and allocation of dedicated time. Keywords: evidence-based practice, faculties, health sciences, attitude- knowledge-behavio

Outcome of surgical management of ruptured Achilles tendon

Introductions: The incidence of Achilles tendon rupture has been increasing worldwide. The optimal management of this problem is controversial but the surgical intervention is being applied widely. Methods: We retrospectively analyzed patients who had Achilles tendon (AT) rupture treated surgically at Patan Academy of Health Sciences from January 2010 to December 2015. Functional outcome assessment of ankle was done by using American Orthopedic foot and Ankle Society Score (AOFAS). Results: Total 71 patients (male 45, female 26) had surgery for AT, 38 right and 33 left side. The mean age of the patient was 36.14 years (range 18-67 years). The mean AOFAS score was 83.32 (range 75-93) after first year follow up and 90.36 (range 80-99) after second year, difference was statistically significant (p<0.05). Conclusions: The study showed high AOFAS score for surgical management of ruptured Achilles tendon.   Key words: Achilles tendon rupture, American Orthopedic foot and Ankle Society Score (AOFAS

Outcome of anterior cruciate ligament reconstruction using bone-patellar tendon-bone auto graft

Introductions: A rupture of the Anterior Cruciate Ligament (ACL) is the most common ligament injury resulting in instability of the knee which can cause secondary articular injury and early osteoarthritis (OA). Aim of this study was to evaluate the short term outcomes of ACL reconstruction using Bone Patellar Tendon Bone Auto Graft (BPTB) auto graft and factors that might contribute to poor results. Methods: Patients with Anterior Cruciate Ligament injury during the period of July 2013 to May 2014 were enrolled to observe the outcome of the ACL reconstruction using BPTB without arthroscopy. Lysholm Knee Scoring Scale was used to determine the clinical outcome. Outcome parameters were evaluated using Statistical Package for Social Science Version 20 (SPSS). Results: Total 30 normal or near normal function outcome of knee was reported in 29 (97%) patients after ACL reconstruction using BPTB without arthroscopy. There was no failure of grafts. Good static knee stability achieved with increased patient’s satisfaction. Lysholm Score was excellent in 27 (90%) and good in 3 (10 %) cases. Anterior knee pain persisted in 6 cases (20%). Conclusions: Excellent functional outcome with BPTB auto graft in Anterior Cruciate Ligament injury was achieved. Keywords: ACL reconstruction, bone-patellar tendon-bone auto graft, clinical outcom

Orthopaedic services during COVID-19 lockdown at Patan Hospital, Nepal

Introduction: The COVID-19 pandemic has paralyzed the world, including elective health care services. To prevent the spread of infection, most countries have gone into lockdown and adjustments have been made to provide urgent medical care, including Orthopaedic services. In accordance with the guidelines from worst affected countries and neighboring India, Patan Hospital followed instructions from Ministry of Health and Population to provide only urgent and semi-urgent Orthopaedic services. This study aims to audit the patient profile during lockdown so as to have a clearer picture, which will enable us to be prepared for similar epidemic in the future. Method: All patients admitted to the Orthopaedic ward of Patan hospital from 24 March to 27 April 2020, during the lockdown, were included. Clinical profile, including cause of admission, management, hospital stay were descriptively analyzed. Ethical approval was obtained. Result: Out of 44 admissions, there were male 27 and female 17. Trauma cases were 38, and 18 were in age group 20-26 years. Admission due to infections were four. Conservative management were done in seven while 33 were treated surgically, out of which 30 accounted for trauma. Average 6.14 days hospital stay, range 1-22 days. Conclusion: Trauma comprised of major bulk of patients seeking urgent Orthopaedic care. Hospital needs to be prepared with necessary measures to ensure safety of health care workers and yet provide urgent Orthopaedic services. Keyword: COVID-19, lockdown, orthopaedic

Minimally Invasive-Closed Reduction and Percutaneous Pinning for Supracondylar Fractures of the Humerus in Children

Introductions: Although Closed Reduction and Percutaneous Pinning is the goldstandard of treatment for Supracondylar fractures (SC) in children, reductionis not always easy. Minimally Invasive, Closed Reduction and PercutaneousPinning (MI-CRPP) reduces the soft tissue trauma and provides easy reduction.We have reviewed the success rate of minimally invasive reduction techniqueand its outcome.Methods: We reviewed the charts of 155 children (97 male, 58 female) ageranging from 2 to 14 years with SC fractures of the humerus who were operatedwith minimally invasive closed reduction and precutaneous pinning fromNovember 2008 to June 2014 at Patan Hospital and Om Hospital. They werefollowed up for a mean of eight (4 to 24) weeks. The K-wires were removed at4 to 6 (average 4.28) weeks.Results: Male children were affected more than female with the ratio being 97to 58. Right side was affected more than left (ratio 89 to 66). Post-operatively,there were six (3.87%) ulnar nerve injury and eight (5.16%) patients came withsuperficial pin tract infection. One hundred and thirteen (72.9%) had excellent,35 (22.58%) good, five (3.23%) fair and two (1.3%) poor results at the eightweek follow-up which was improved to 144 (92.9%) excellent, seven (4.5%)good, three (1.9%) fair and one (0.65%) poor results at the 14 week follow-up.Conclusions: Closed reduction of supracondylar fractures of the humerus inchildren with minimally invasive technique prior to K-wire fixation is a relativelysimple, safe and effective method of achieving satisfactory reduction and goodfunctional outcome.Keywords: cubitus varus deformity, K wire fixation,minimally invasive closedreduction and precutaneous pinning, supracondylar fracture

Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2017: A systematic analysis for the Global Burden of Disease Study 2017

Copyright © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Background: How long one lives, how many years of life are spent in good and poor health, and how the population's state of health and leading causes of disability change over time all have implications for policy, planning, and provision of services. We comparatively assessed the patterns and trends of healthy life expectancy (HALE), which quantifies the number of years of life expected to be lived in good health, and the complementary measure of disability-adjusted lifeyears (DALYs), a composite measure of disease burden capturing both premature mortality and prevalence and severityof ill health, for 359 diseases and injuries for 195 countries and territories over the past 28 years. Methods We used data for age-speci?c mortality rates, years of life lost (YLLs) due to premature mortality, and years lived with disability (YLDs) from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to calculate HALE and DALYs from 1990 to 2017. We calculated HALE using age-specific mortality rates and YLDs per capita for each location, age, sex, and year. We calculated DALYs for 359 causes as the sum of YLLs and YLDs. We assessed how observed HALE and DALYs differed by country and sex from expected trends based on Sociodemographic Index (SDI). We also analysed HALE by decomposing years of life gained into years spent in good health and in poor health, between 1990 and 2017, and extra years lived by females compared with males. Findings Globally, from 1990 to 2017, life expectancy at birth increased by 7·4 years (95% uncertainty interval 7·1-7·8), from 65·6 years (65·3-65·8) in 1990 to 73·0 years (72·7-73·3) in 2017. The increase in years of life varied from 5·1 years (5·0-5·3) in high SDI countries to 12·0 years (11·3-12·8) in low SDI countries. Of the additional years of life expected at birth, 26·3% (20·1-33·1) were expected to be spent in poor health in high SDI countries compared with 11·7% (8·8-15·1) in low-middle SDI countries. HALE at birth increased by 6·3 years (5·9-6·7), from 57·0 years (54·6-59·1) in 1990 to 63·3 years (60·5-65·7) in 2017. The increase varied from 3·8 years (3·4-4·1) in high SDI countries to 10·5 years (9·8-11·2) in low SDI countries. Even larger variations in HALE than these were observed between countries, ranging from 1·0 year (0·4-1·7) in Saint Vincent and the Grenadines (62·4 years [59·9-64·7] in 1990 to 63·5 years [60·9-65·8] in 2017) to 23·7 years (21·9-25·6) in Eritrea (30·7 years [28·9-32·2] in 1990 to 54·4 years [51·5-57·1] in 2017). In most countries, the increase in HALE was smaller than the increase in overall life expectancy, indicating more years lived in poor health. In 180 of 195 countries and territories, females were expected to live longer than males in 2017, with extra years lived varying from 1·4 years (0·6-2·3) in Algeria to 11·9 years (10·9-12·9) in Ukraine. Of the extra years gained, the proportion spent in poor health varied largely across countries, with less than 20% of additional years spent in poor health in Bosnia and Herzegovina, Burundi, and Slovakia, whereas in Bahrain all the extra years were spent in poor health. In 2017, the highest estimate of HALE at birth was in Singapore for both females (75·8 years [72·4-78·7]) and males (72·6 years [69·8-75·0]) and the lowest estimates were in Central African Republic (47·0 years [43·7-50·2] for females and 42·8 years [40·1-45·6] for males). Globally, in 2017, the ?ve leading causes of DALYs were neonatal disorders, ischaemic heart disease, stroke, lower respiratory infections, and chronic obstructive pulmonary disease. Between 1990 and 2017, age-standardised DALY rates decreased by 41·3% (38·8-43·5) for communicable diseases and by 49·8% (47·9-51·6) for neonatal disorders. For non-communicable diseases, global DALYs increased by 40·1% (36·8-43·0), although age-standardised DALY rates decreased by 18·1% (16·0-20·2). Interpretation With increasing life expectancy in most countries, the question of whether the additional years of life gained are spent in good health or poor health has been increasingly relevant because of the potential policy implications, such as health-care provisions and extending retirement ages. In some locations, a large proportion of those additional years are spent in poor health. Large inequalities in HALE and disease burden exist across countries in different SDI quintiles and between sexes. The burden of disabling conditions has serious implications for health system planning and health-related expenditures. Despite the progress made in reducing the burden of communicable diseases and neonatal disorders in low SDI countries, the speed of this progress could be increased by scaling up proven interventions. The global trends among non-communicable diseases indicate that more effort is needed to maximise HALE, such as risk prevention and attention to upstream determinants of health