Hand Injuries in the Oil Fields of Brunei Darussalam

Hands are essential organs and their agility and dexterity are vital to our daily lives. In the present study, we analysed 107 patients who presented at the local hospital with hand injuries sustained in the oil fields, oil industries and related employment sectors from the surrounding regions. All the patients were male and the mean age was 37.89 years (range,21-61y). Forty-seven (43.93%) patients had simple cut injuries, 14 patients (13.08%) had tendon injuries, 13 patients (12.14%) had amputation of the digit (30.84%) had bone fractures (including 20 (66.66%) open fractures). Only 19 (17.75%) patients were admitted in hospital for further treatment. Ninety-one (85.04%) patients injured within one year of employment and 57(53.27%) patients were not satisfied with instructions and orientation before starting their job. Hand injury is one of the most common injuries in the oil industry and overtime work further increases incidence of this injury

Surgical Management of Pyogenic Discitis of Lumbar Region

Study DesignRetrospective review of patients who had pyogenic discitis and were managed surgically.PurposeTo analyze the bacteriology, pathology, management and outcome of pyogenic discitis of the lumbar region treated surgically.Overview of LiteratureSurgical management of pyogenic discitis is still an infrequently used modality of treatment.MethodsA total of 42 patients comprised of 33 males and 9 females who had pyogenic discitis with a mean age of 51.61 years (range, 16-75 years) were included in this study. All the cases were confirmed as having pyogenic discitis by pus culture report and histopathological examination. The mean follow-up period was 41.9 months.ResultsDebridement and posterior lumbar interbody fusion with autologous iliac bone graft was done in all cases. Thirteen (30.95%) patients had other medical co-morbidities. Five cases had a previous operation of the spine, and three cases had a history of vertebral fracture. Three patients were operated for gynaecological problems, and four cases had a history of urological surgery. L4-5 level was the most frequent site of pyogenic discitis. The most common bacterium isolated was Staphylococcus aureus (S. aureus). Radiologically good fusion was seen in the majority of patients.ConclusionsPyogenic discitis should be suspected in people having pain and local tenderness in the spinal region with a rise in inflammatory parameters in blood. The most common bacterium was S. aureus, but there were still a greater number of patients infected with other types of bacteria. Therefore, antibiotics therapy should be started only after isolating the bacteria and making the culture sensitivity report

Priority public health interventions and research agendas in post-earthquake Nepal

The occurrence of natural disasters including earthquake is becoming more frequent phenomena worldwide. All these disasters trigger huge damages to infrastructure, economies as well as population health. Nepal’s earthquake in 2015 has multiple effects on population health and health services delivery. Many public health facilities, mostly health posts or sub-healthposts, were damaged or completely destroyed. Priority health services such as immunization and antenatal care were also seriously affected. The earthquake has prompted the need for a disaster-related population-health-research agenda as well as renewed disaster strategy in post-earthquake Nepal. Meanwhile, it also unveiled the gap in knowledge and practice regarding earthquake resilience in Nepal. There is an opportunity for school-based and community-based interventions in both disaster preparedness and resilience. Nepal can build on experiences from other countries as well as from its own. We have discussed possible impacts of the Nepal earth- quake on population health and health system infrastructures. We have also suggested possible public health interventions bestowing active awareness among the population and a research agenda in this regard. We strongly urge for the translation of the National Health Policy (2014) into action, as it prioritizes the need of an earthquake resistant infrastructure as well as the implementation of a disaster response pla

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

Minimally Invasive Plate Osteosynthesis In The Treatment Of Isolated Ulnar Bone Fractures

BACKGROUND: Minimally invasive internal fixation is also called “biological internal fixation”. This concept is used widely in the treatment of various fractures but to date, there have been no report about such application in the repair of isolated ulnar bone fractures. METHODS: Eleven patients with fracture of isolated ulnar bone (four AO type 22A11 and seven AO type 22A12), mean age 43.16 (range, 24- 59y), were treated using closed reduction and locking compression plate with minimally invasive plate osteosynthesis (MIPO) with the aim of minimising soft tissue damage. RESULTS: Fractures healed at an average of 7.8 weeks with good to excellent clinical outcomes. There were no complications such as nonunion, implant failure or neurovascular injuries. CONCLUSIONS: MIPO seems to be advantageous for soft tissue and bone biology. Good union was seen and fracture complications were also prevented by early mobilisation

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

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