Introduction: Clavicle fractures are the common fractures around the shoulder. Conservative treatment is as­sociated with higher incidence of nonunion. We conducted this study to assess the functional outcome of plat­ing for displaced middle third clavicle fractures. Methods: This prospective study included 60 patients with displaced middle third clavicle fractures from April 2016 to March 2017. Fixation was done with a 3.5 mm reconstruction plate placed at the superior surface of the clavicle. Patients were followed-up for a minimum of one year. Functional outcome was assessed using Constant shoulder score. Results: There were 48 male and 12 female patients with a mean age of 33.17 years (range 18-74 years). The average follow-up period was 17.82 months. All fractures united at an average of 5.35 months. The mean Constant score at final follow-up was 89.12. There were two superficial infections and three implant failures. Conclusion: We conclude that treat­ment of displaced middle third clavicle fracture with plate gives good results.

Background: The Corona virus disease (COVID-19) pandemic has been a global health crisis and has affected Nepal also. As a strategy to control the disease outbreak, the government of Nepal had introduced a four-month nationwide lockdown. This study aims to evaluate the impact of the national lockdown in orthopedic services in Chitwan Medical College. Methods: This cross-sectional analytical study included all the patients admitted and treated in the orthopedic department of Chitwan Medical College during lockdown period from 24 March to 21 July 2020, which was compared with the same four-month interval from 24 March to 21 July in 2019. Data collected included patient demographics, mechanism of injury, anatomical location, waiting time before surgery and hospital stay. Results: A total of 247 patients were treated during lockdown, with a reduction of 45.4% from 2019 (452 patients). Also, there was 39.1% (340 vs 207, p=0.009) reduction in trauma cases and 35.7% (347 vs 223, p=0.000) reduction in cases operated in lockdown. There was a decrease in pediatric patients during lockdown (p=0.044). Fall was the most common mechanism of injury in both groups (p=0.158) with decrease in road traffic accidents during lockdown 27.1% (n=56) vs 45% (n=153) in 2019 (p=0.000). The waiting time before surgery and hospital stay were also shortened (p=0.000). Conclusions: The impact of lockdown resulted in decreased number of orthopedic trauma admis­sions and cases operated. On such a crisis, only urgent and semi-urgent cases need to be managed while also protecting healthcare workers and patients

Introduction: Distal radius fractures are the most common fractures in elderly. Unstable fractures are best managed surgically and the results of volar locking plates have been promising. The purpose of this study is to determine the functional outcome of volar locking plates in the treatment of unstable distal radius fractures. Methods: Forty-five patients with 46 unstable distal radius fractures were enrolled for this study, conducted at Chitwan Medical College from September 2016 to April 2017. All patients were treated with a 3.5mm titanium volar locking plate and followed-up for a minimum of one year. The assessment was done using radiological evaluation and Cooney modification of the Green and O’Brien scoring system. Results: Twenty-three men and 22 women with age ranging from 15-75 years (mean 43.22 years) were followed-up for an average of 16.53 months. There were 17 type A fractures (5 A2, 12 A3), 11 type B fractures (3 B1, 1 B2, 7 B3), and 18 type C fractures (4 C1, 12 C2, 2 C3) (AO classification). The mean time for union was 7.96 weeks. Functional outcome using modified Green and O’Brien Score was 20 excellent, 15 good, 7 fair and 4 poor results (76.1% good to excellent results). The overall complication rate was 15.22%. Conclusion: Volar locking plates provide adequate fixation for unstable distal radius fractures with minimal loss of reduction and satisfactory functional outcome.

Rockwood classification of AC joint dislocation is generally accepted worldwide. Treatment of Rockwood Type 1 and 2 AC joint is non-operative while all authors advocate operative treatment for Rockwood Type 4 and 5 AC joint dislocations. Thirty consecutive patients who underwent operation for acromioclavicular joint dislocation using clavicle hook plate from June 2015 were studied. The dislocations ranged from Rockwood type III to type V. Average follow up time was fourteen months ranging from four to twenty-four months. The outcome was measured using University of California Los Angeles (UCLA) shoulder score. All-the patient had good to excellent result.

Background: Pain is an unpleasant sensation and occurs frequently in the post-operative period. Pain impairs treatment and recovery of patients and thus should be adequately managed. This study aimed to assess the intensity of pain in the post-operative patients undergoing orthopedic surgery and to evaluate the adequacy of the analgesics used. Methods: This was a prospective observational study conducted at Chitwan Medical College, Department of Orthopedics from May to August 2019. Ninety-six patients who underwent orthopedic surgery were evaluated upto 72 hours after surgery and assessed for pain using interview, Visual Analogue Scale and medical record analysis. Type of analgesic used and its adequacy, using Pain Management Index, were also studied. Results: There were 58 male and 38 female patients with age 18-79 years (mean 38.16 ± 16.34 years). 97.9% patients complained of pain in immediate, 91.7% in 1st and 82.3% in 2nd post-operative period with mean Visual Analogue Scale scores of 6.68, 3.74 and 2.68 respectively. Non-steroidal anti-inflammatory drug was the most frequently prescribed analgesic followed by its combination with opioid. Pain management was inadequate in immediate post-operative (61.5%), but there was significant improvement in 1st and 2nd post-operative period (inadequate Pain Management Index in 28.1% and 12.5% respectively). Conclusions: Most patients experienced pain in the post-operative period, but the intensity decreased as the post-operative hours passed by. Pain management in the immediate post-operative period was inadequate in our study and therefore proper attention should be given to manage pain in the post-operative period.