Background: Tennis elbow or lateral epicondylitis is characterised by pain and tenderness at the lateral epicondyle of humerus. There are various treatment modalities recommended, but there is no universally accepted therapeutic modality yet. Objectives: To compare the functional outcomes of local injection of corticosteroid versus autologous whole blood for tennis elbow. Methods: This was a non-randomised trial conducted from May 2020 to January 2021 after ethical clearance. Patients attending orthopaedic surgery outpatient department, Kathmandu Medical College with lateral epicondylitis of the humerus were included by convenience sampling into corticosteroid group or autologous blood injection group based on whether they presented on odd or even calendar days respectively. There were 38 patients in corticosteroid group and 36 patients in autologous blood group. The visual analogue scale (VAS) and Nirschl staging system were calculated before injection, and then at one week, six weeks, and six months after injection. Results: Patients in both groups showed statistically significant decrease in pain from preinjection scores on both VAS and Nirschl scale at all follow-ups. There was no statistically significant difference between the two groups up to six weeks. At six months, autologous blood injection group showed statistically significant decrease in pain compared with corticosteroid injection group on both scoring systems. Conclusion: Both groups showed comparable improvement up to six-week follow-up. Autologous blood injection group had significantly better improvement at six months. Autologous blood injection was more effective than corticosteroid injection at midterm follow-up, and had lower recurrence rate.

Background: Unstable thoracolumbar burst fractures are treated surgically by short segment fixation but may be associated with high implant failure. Supplementation of anterior column by insertion of screw at fracture site makes it more biomechanically stable.Objectives: The purpose of this prospective study was to evaluate radiological parameters in thoracolumbar fractures treated with intermediate screw fixation with a minimum follow up of two years.Methods: This prospective study was conducted from 2011 till 2012 where unstable  thoracolumbar fractures treated with short segment posterior instrumentation with screw at fracture site were evaluated. All patients (average age 34.64 were followed up for at least 24 months and were classified according to Thoracolumbar Injury Classification and Severity Score and load sharing classifi cation. Out of total 32 patients, four lost to follow up. Radiological parameters like vertebral body height and segmental kyphosis were evaluated and pain was evaluated by Visual Analogue Scale score.Results: Preoperative pain showed mean Visual Analogue Scale Score score of 8.29 that improved to 0.97 at fi nal follow up. Average preoperative loss of vertebral body height was 48.19 %, which improved to 11.4 % after surgery (p<.001). Final vertebral body collapse was 12.98 % with mean percentage loss of vertebral height at 1.57%. Average segmental kyphotic angle was 22.54 before surgery, which corrected to 5.89 immediately after surgery (p<0.001). Final segmental kyphosis was 8.46. Loss of kyphosis correction was 2.57. Two patients had implant failure, but was solidly united during implant removal in both cases.Conclusion: Excellent maintenance of reduction in thoracolumbar burst fractures with short segment fixation with intermediate screws at fracture site with limited decompression resulted in improved neurologic function and satisfactory clinical outcomes, with a low incidence of implant failure and progressive deformity.

Background: Local corticosteroid preparations are conventionally mixed with local anaesthetic agents to reduce pain during injection for various soft tissue affections in Orthopaedics. Although it can anaesthetise the area after injection, the infiltration process itself can be more painful because of low pH of the lidocaine. Objectives: To assess whether addition of lidocaine actually reduces pain during local steroid injection. Methods: This was a prospective comparative study conducted at Kathmandu Medical College over a period of nine months from June 2020 to February 2021 after obtaining ethical clearance. Patients requiring local corticosteroid injection for various indications in Orthopaedics were included by convenience sampling and divided into two groups. Out of 147 patients, 75 received steroid with lidocaine and 72 with normal saline. The Visual Analogue Score was recorded immediately along with injection in a scale of 0 to 10 where 0 meant no pain at all and 10 meant maximum pain imaginable. The difference in median Visual Analogue Score and the mean cost of injection between two groups was compared. Findings were analysed using SPSS v.20. Results: Median Visual Analogue Score in lidocaine group was 5 whereas in normal saline group was 4 (p-value = 0.33, Mann-Whitney U test). The mean cost of injection in lidocaine and normal saline groups were Nepali Rupees  339.3 ± 37.7 and 282.3 ± 36.7 respectively (p <0.001, Student’s t-test) Conclusion: Removal of lidocaine from steroid preparations in orthopaedics does not make it more painful if not less. It also reduces the cost of injection.

Introduction: Long bone fractures are among the most common orthopaedic injuries encountered. A fracture that fails to progress to union despite appropriate fixation and absence of complications presents a treatment dilemma to the surgeon. The usual solution of re-fixation with or without bone graft constitutes repeat exposure to surgery and its risks, as well as added morbidity and cost. Recent advances in molecular biology suggest Platelet rich plasma (PRP) may have bone forming potential. This study was done to determine whether PRP has any beneficial role in patients with delayed healing of long bone fractures. Methods: A prospective interventional study was done on patients arriving at the department of orthopaedic surgery of Kathmandu Medical College with delayed union of long bone fractures after internal fixation between January 2014 and January 2017. Patients were treated with local injection of group-matched PRP directly into the fracture gap and were followed-up for six months to check for radiological signs of fracture union. Results: A total of 10 fractures were included in 10 patients that involved four humeri, three tibiae, and three femora. Eight out of the 10 fractures united at a median time of three months after the injection. Two had non-union that required revision surgery. Conclusion: Local Platelet rich plasma injection may constitute a ‘nothing to lose, everything to gain’ intermediate option before a decision for major reoperation on such patients is made.

Introduction: Non-steroidal anti-inflammatory drugs are major drugs in treatment of pain and inflammation of different orthopedic conditions. There are different classes of non-steroidal anti-Inflammatory Drugs based on their selectivity to cyclooxygenase enzyme which has significant differences in safety profile. This study aims to determine the prevalence of non-steroidal anti-inflammatory drugs prescription in the orthopaedic outpatient department of a tertiary care hospital. Methods: This was a descriptive cross-sectional study conducted among the patients in the orthopedic outpatient department of tertiary care hospital from December 2020 to March 2021. Ethical approval was taken from the Institutional Review Committee of the college (Ref: 0311202007). Convenient sampling was done. A structured proforma was used with consent. The data were analyzed with Social Statistical Package for the Social Sciences version 20. Point estimate at 95% Confidence Interval was done and frequency and percentage were calculated. Results: Out of 140 orthopaedic out patient department prescriptions screened, 118 (84.28%) (78.25-90.30 at 95% Confidence Interval) prescriptions included non-steroidal anti-inflammatory drugs. Aceclofenac 76 (64.4%) was the most prescribed non-steroidal anti-inflammatory drug. Conclusions: Aceclofenac was the most preferred agent for the treatment in the department of orthopedics. The most common proton pump inhibitor used alone with non-steroidal anti-inflammatory drugs was rabeprazole.

Background: Anterior cruciate ligament injury (ACL) is a common injury in both sporting and non-sporting population. All patients with an ACL injury may not require surgery. The criteria for deciding whether a reconstruction should be performed are not absolute and the trend is to offer reconstruction to the sporting population as they require a stable knee to perform in their line of work. The non-sporting population also require a stable knee to perform their daily activities. Objectives: To assess functional outcome in the non-sporting patients following reconstruction. Methods: A prospective observational analytical study was conducted in the age group from 18 to 55 years, with symptomatic ACL injury who were not involved in sporting activities from July 2020 to December 2021. Fifty patients participated in the study. Convenience sampling technique was used. The IKDC and Lysholm scores were used preoperatively and six months post-operatively to assess the benefit of the treatment. Results: Out of 50 patients, four were lost to follow up. Out of total 46 patients, 29 (63.04%) patients were male and 17 (36.96%) patients were female. The mean age of patients was 31.61 ± 7.38 years. The IKDC and Lysholm scores measured preoperatively were 47.07 ± 7.51 and 52.17 ± 7.91 and the six-month post-operative scores were 86.73 ± 5.54 and 90.69 ± 4.63 respectively. Conclusion: The patients from the non-sporting population who underwent ACL reconstruction had significantly improved IKDC as well as Lysholm scores compared to their function prior to the procedure.

Background: The pain and limitation of shoulder function can disrupt daily activities of patients for months to years. Adhesive capsulitis is considered a self-limiting disease but the duration remains uncertain. The brunt of the disease is focussed on the inflamed joint capsule. On this basis, use of corticosteroid injection is justified. However, injection method is not conclusive. Objectives: To compare clinical benefits of intra-articular injection alone versus combined intra-articular and subacromial injections in management of adhesive capsulitis. Methods: Fifty-nine patients with diagnostic criteria for adhesive capsulitis were included in the study from March 2019 to September 2020. Patients were divided into two groups; patients who underwent intra-articular (IA) injection alone (Group 1) and those who received both intra-articular and sub-acromial (IA+SA) injection (Group 2). The injections were landmark guided. Patients were followed up at three, six, and 12 weeks. Pain was recorded using visual analogue scale (VAS) and subjective function using Constant-Murley score. Results: Twenty-eight patients were included in Group 1 (IA) and 31 in Group 2 (IA+SA). Thirty-six patients were female (18 each in Group 1 and Group 2) and 23 patients were male (Group 1 = 13; Group 2 = 10). In the twelfth week, VAS score was reduced in both the groups. On comparing the mean value of Constant-Murley score between the two groups there is significant difference in value recorded at the sixth and twelfth week. Conclusion: The IA+SA injection provides significant reduction in pain and better function in the short term over the IA injection.