INTRODUCTION: The palmaris longus (PL) is a tendinous superficial flexor of forearm. It basically, anchor skin and fascia of hand resist the horizontal shear force in distal direction. It also helps in tightening of palmar aponeurosis. Along with other flexor muscle it also helps in flexion of wrist joint. The incidence of absence of palmaris longus is in great variation from 1.5 to 63.9%. Its variation of absence has attracted many researchers globally. The aim of the present study is to know occurrence of absence of PL in Nepalese population. MATERIAL AND METHODS: This is a   cross sectional   descriptive observational study conducted among 270 medical students (MBBS, BDS) at Universal College of Medical Science, Bhairawaha in year the  2018-2019. Ethical approval for study was taken from institutional review committee (IRC). Four tests-Schaeffer's Test, Thompson's Fist, Mishra's Test and Puspa Kumar's two finger sign were used to see the absence/presence of Palmaris longus. A semi-structured proforma was used to collect the data. RESULTS: Out of 270 students, there were 145 (53.7%) females and 125 (46.3%) males. Age of the subject range from 19-23 years with a mean age of 19.91  years. The overall absence of palmaris longus was seen in 40 students (14.8%) which included 18 males (14.4%) and 22 females (15.2%). Bilateral absence of palmaris longus was seen in 10 students (3.7%) whereas unilateral absence of palmaris longus was seen 14 males (11.2%) and 16 females (11.03%). CONCLUSION: This present study concluded that overall absence of palmaris longus was seen in 14.8% subjects. Gender wise distribution showed that 14.4% males and 15.2%  had the absence of palmaris longus. Thus, sound knowledge about this variation is important in planning graft surgeries.

Study design: Cross-sectional studyObjectives: To identify the prevalence of posttraumatic stress disorder (PTSD) among the individuals with traumatic spinal cord injury (TSCI) and to examine the relationships between demographic and clinical characteristics, and PTSD.

Spinal cord injury (SCI) leads to disabling condition. In Nepal the nationwide statistics of incidence and prevalence of SCI is still unclear which demands a systematic examination of crucial epidemiological aspects of SCI. An electronic search was conducted on PubMed, Ovid EMBASE, Cochrane Library and Google Scholar. Clinical studies investigating epidemiology of spinal cord injury were included. A narrative synthesis of the data that comprised 1796 patients was conducted. Males comprised 73%, and the mean age varied from 32 to 47 years. The two leading causes of SCI were falls (60%) and accidents (17%). Most patients had incomplete neurology (AIS grade B, C and D = 42%) followed by AIS A grade (36.3%). Cervical injury (37.4%) was the most common level of injury. Mortality during hospital stay was low (1.98%) whereas after rehabilitation was high (24.32%). The review contributes in understanding epidemiology of SCI in Nepal which is expected to help in planning for prevention and management.

Background The Nepal government issued a nationwide lockdown due to COVID-19 from 24 March to 21 July 2020. This halted elective medical services in our hospital. A number of modifications in the orthopaedic practices at our department were made. Objective This article discusses the impact on orthopaedic load at the Department of Orthopaedics and Trauma, Dhulikhel Hospital, Kathmandu University Hospital during the lockdown. Method This is a longitudinal observational study done during the nation-wide lockdown including all the patients who presented to the hospital requiring orthopaedic consultation. For comparison purposes, the patient numbers from the same date in previous year (2019) were retrieved. Result We received no COVID-19 cases requiring orthopaedics consultation. A total of 1828 patients were seen in the Orthopaedic Outpatient Department, 1077 trauma patients in the Emergency Department, 216 patients were admitted and 210 orthopaedics procedures were performed at the operation theatre. There was 82.21% decrease in OPD patients and 56% less surgeries in OT compared to the same duration of last year. Conclusion There was a great reduction in the patient numbers visiting the hospital, which reflected in decreased number of admission and surgery. A greater part of our work during the lockdown was trauma.

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IntroductionFunctional outcome and quality of life (QoL) of patients will change following tibial plateau fracture fixation. There are limited studies evaluating functional and radiological outcomes following tibial plateau fixation in Nepal, and none has evaluated QoL. We aim to evaluate functional outcome and QoL in patients with tibial plateau fracture with a follow up period of more than two years. MethodsThis was a cross sectional, observational study done at Dhulikhel Hospital, from August 2021 to January 2022. Western Ontario and McMaster Universities Arthritis Index (WOMAC) functional outcome and World Health Organization QoL-8 (WHOQoL-8) questionnaire were filled by patients operated for tibial plateau fracture from 2011 to 2019. Compound fractures, untraceable patients, and those managed with casts were excluded from the study. ResultsThere were 121 patients (male: female = 2.3:1) with a mean age of 37.1 years. Road traffic accidents (44.6%) were the most common mode of injury, and Schatzker type IV (30.6%) was the most common type of fracture. The average WOMAC score was 13.05±12.1 and the average WHOQoL-8 score was 30.24±4.1. The average WOMAC score in high-energy and low energy trauma patients were 17.07±12.29 and 8.21±10 respectively. The average WHOQoL-8 in high energy and low energytrauma patients were 29.28±3.59 and 31.38±4.38 respectively. ConclusionsSurgical reduction and stable internal fixation of tibial plateau fractures with long term follow up has a good functional outcome and quality of life. High energy trauma is associated with poor functional outcome and quality of life.

INTRODUCTION: Acromioclavicular joint dislocation is a commonly encountered shoulder injury. Various surgical methods are available for the treatment of complete ACJ dislocation (type III to VI), however, optimal surgical treatment is still controversial. The purpose of this study was to evaluate the radiological and functional outcome of anatomic coracoclavicular reconstruction (ACCR) using semitendinosus autograft with suture augmentation for type III to V ACJ dislocation. MATERIALS AND METHODS: It was a single centered, cross sectional, observational study conducted at Department of Orthopedics and Traumatology, Dhulikhel Hospital. Twenty-three consecutive patients who underwent ACCR with semitendinosus autograft from Jan 2017 to Dec 2019 were included in the study. Patients below 18 years of age and patients with previous ipsilateral shoulder injury were excluded. The radiological outcome was assessed using coracoclavicular (CC) distance and functional outcome using DASH score and Constant score. Paired t-test and Pearson correlation were used for inferential analysis. RESULTS: Mean age of the patient was 33.83 ± 7.08 years. Mean duration of follow up was 28.17 ± 6.19 months. Mean CC distance at final follow up was 9.93 ± 1.12 mm. Mean DASH score was 5.60 ± 5.35 and mean Constant score was 88.04 ± 12.13. There were 12 (52.17%) excellent outcomes, 6 (26.08%) good outcomes, 2 (8.69%) fair outcomes and 3 (13.04%) poor outcomes based on Constant scores. CONCLUSIONS: ACCR with suture augmentation is an effective method for management of type III to V acromioclavicular joint dislocation.

Background Monteggia fracture dislocation may need operative management. The fracture of ulna is reduced by closed or open reduction followed by stabilization of ulna with Rush pin, K-wires or Dynamic compression plate. Objective To evaluate the Mayo Elbow Performance Score of patients with Monteggia fracture dislocation treated operatively. Method It is a retrospective study conducted at Dhulikhel Hospital, Kathmandu University Hospital. All the pediatric patients with Monteggia fracture dislocation managed operatively from January 2011- December 2019 were included in the study. The functional outcome scoring of the effected elbow using Mayo Elbow Performance Score was done in the last follow up. Result Forty eight surgically managed Monteggia patients had a mean age of 7.23 ± 2.9 years with male predominance. Left side was the dominant side of involvement with 29 patients. Bado type 1 was the most common type (81.3%). Most of the patient underwent closed reduction and fixation with Rush pin (n=40). All of the patient has excellent (89.6%) to good (10.4%) functional outcome. Conclusion Operative management of Monteggia fracture dislocation with complete ulna fracture has excellent to good outcome.