The aim of this prospective study was to assess

We conducted a randomised controlled trial to compare external fixation of trochanteric fractures of the femur with the more costly option of the sliding hip screw. Patients in both groups were matched for age (mean 67 years, 50 to 100) and gender. We excluded all pathological fractures, patients presenting at more than one week, fractures with subtrochanteric extension or reverse obliquity, multiple fractures or any bone and joint disease interfering with rehabilitation. The interval between injury and operation, the duration of surgery, the amount of blood loss, the length of hospital stay and the cost of treatment were all significantly higher in the sliding hip screw group (p < 0.05). The time to union, range of movement, mean Harris hip scores and Western Ontario and McMaster University knee scores were comparable at six months. The number of patients showing shortening or malrotation was too small to show a significant difference between the groups. Pin-track infection occurred in 18 patients (60%) treated with external fixation, whereas there was a single case of wound infection (3.3%) in the sliding hip screw group.

Purpose Long arm cast is the method of immobilization after closed reduction of the fracture of the distal third of the forearm, although short arm cast has been used to immobilize the forearm by some orthopedic surgeons. We conducted this study to evaluate the rate of displacement, union time, complication, and cost of treatment between the above-elbow and below-elbow plaster cast groups. Methods We designed a prospective randomized controlled trial to compare above-and below-elbow casts for patients of distal forearm fracture aged 4-12 years. One hundred and one patients were presented to our institution during the period from 1st June 2007 to 31st May 2008. Twelve patients were excluded from the study. Eighty-nine patients were randomized into two groups. Four patients were lost to follow up. Hence, 85 patients, 42 in the aboveelbow group and 43 in the below-elbow group, were analyzed. Informed consent was obtained prior to participation in the trial. The parameters to be studied were defined before treatment and noted in the pilot-tested pro forma and follow up was done. Results Among the 85 patients analyzed, randomization was successful. Pain and swelling on the next day and at one week following cast application was significantly higher (P = 0.000) in the above-elbow group. Three cases in the above-elbow group needed slitting of the plaster cast. Remanipulation was needed more often in the above-elbow group (9.5%). Although the cast index was not statistically significant (P = 0.054) between the groups, those who needed remanipulation had a larger cast index (0.80). The total cost of the treatment and the number of school days lost was significantly higher (P = 0.000) in the aboveelbow group. Conclusion Below-elbow cast treatment was comparable in terms of redisplacement, union time, and movement of the wrist to the above-elbow treatment. The complications rate and total cost was higher in the above-elbow plaster group, which could be a cost benefit if a below-elbow cast is used.

Klippel-Trenaunay syndrome (KTS) is a rare complex malformation characterized by the clinical triad of capillary malformations, soft tissue and bone hypertrophy, and venous/lymphatic malformation. Fractures of long bones in such cases are challenging to treat. A 12-year-old female with this syndrome presented with femoral shaft fracture of right thigh. She was initially kept on skeletal traction for two weeks and then she underwent closed reduction and immobilization with external fixator with uneventful intraoperative and postoperative period. Fracture united at four and half months.

Introduction: The prevalence of back pain is very high in the general population but little is known about the predictors of back pain in the general population. Though certain risk factors have been associated with back pain, these are mentioned in Western literature. It is not known how much of these hold true for a developing country like Nepal. Objective: To estimate the prevalence of back pain in the Teaching Districts of B.P.Koirala Institute of Health Sciences and to identify predictors of back pain in the community. Materials and Methods: Three hundred and fourteen persons of eighteen years and above were included in this cross-sectional descriptive study conducted from January 2006 to December 2009 using pretested questionnaires. Results: The annual prevalence of back pain among males (67.9%) and females (74.3%) were similar (P>0.05) and the overall annual prevalence was 71%. The highest prevalence of back pain was found in the age group of 31-40 years. Age, marriage and occupation were related significantly to the occurrence of back pain. The total duration of back pain in one year was less than 15 days in 73%. The number of workdays lost was upto 5 in 81% of people with back pain. Conclusion: Back pain is a very common complaint among the adult population in the community. Population belonging to 31-50 age group, married status and farmers and labourers are more prone to have back pain. Gender, height and weight are not associated with back pain.

We conducted a randomized controlled trial comparing EUSOL (Edinburgh University Solution of Lime) and sugar as dressing agents in the treatment of traumatic wounds. Patients in both groups were matched for age and gender. We found EUSOL did better than sugar in terms of contraction of size of wound, presence of discharge, floor area covered with slough, formation of healthy granulation and early possibility of wound coverage.

Introduction: With the dramatic success of intramedullary fixation for fractures of the femur and tibia, there was speculation that Intramedullary Interlocking Nails might be more appropriate for humeral shaft fractures in comparison to Dynamic Compression Plates. There are very few studies comparing these two methods of fixation in shaft of humerus fractures and virtually no study in this part of world. The aim of the study was to compare these fixation methods in terms of duration of operating time, amount of blood loss, rate of infection, pain at the fracture site, time to achieve union, functional outcome(DASH score) and complications of surgery. Methods: This was randamised control trial in which all patients with fractures of shaft of humerus that met the criteria for operative interventions ( intramedullary interlocking nailing and dynamic compression plating) presenting to the department of Orthopaedics BPKIHS during the study period and giving informed consent were included in the study. The patients were randomized using Excel random number generation technique into two groups. N Group: Cases treated with intramedullary interlocking nail and P Group: Cases treated with dynamic compression plate. Results: Most of the patients were right handed. The operating time for nailing was 100±11.24 minutess in comparision to 90.25± 15.6 minutes for humerus plating. The mean blood loss in nail group was 148.75 ±36.70 while in plate group blood loss was 205±45.60. Post operative hospital stay was similar in both groups with mean stay of 4.5 days.The peroperative radial nerve palsy was 4% in nailing group as compared to 2% in plating group. Radiologically four cortices union was only 50% in nailing group while it was 80% in plating group at 24 weeks post operatively. Dash score gradually improved in both nail and plate group but Dash score was significantly higher in plating group at 6,12,18 and 24 weeks follow up. Conclusion: Dynamic compression plating is better for fracture shaft of humerus. Plate osteosynthesis remains the gold standard of fixation for humeral shaft fractures. DOI: http://dx.doi.org/10.3126/noaj.v3i2.9513 NOAJ July-December 2013, Vol 3, Issue 2, 10-13

Background: The optimal method of humeral shaft fracture fixation remains debatable. With the dramatic success of intramedullary fixation for fractures of the femur and tibia, there was speculation that IM-ILN might be more appropriate for humeral shaft fractures than DCP. Objectives: To compare the fixation of fracture shaft of humerus with interlocking nail and dynamic compression plate in terms of duration of operating time, amount of blood loss, rate of infection, pain at the fracture site, time to achieve union, functional outcome (DASH score) and complications of surgery. Methods: This was randomised control trial study. All patients with fractures of shaft of humerus that met the criteria for operative interventions presenting to the Department of Orthopaedics, BPKIHS in the study period and giving informed consent were included in the study. Sample size was taken 30 in each group. Results: The usual mode of injury in both the groups were road traffiic accident followed by fall from height, work place injury. The operating time for nailing was 100 mins with standard deviation of 11.24 while that of humerus plating was 90.25 with standard deviation 15.6.The mean blood loss in nail group was 148.75 with standard deviation of 36.70 while that in plate group was 205.00 with standard deviation of 45.60. Post operative hospital stay was similar in both groups with mean stay of 4.5 days. DASH was significantly higher in plating group at 6,12,18 and 24 weeks follow up. This showed better functional outcome in nailing group. Conclusion: Dynamic compression plating is better than interlocking nail for fracture shaft of humerus. Keywords: shaft of humerus; interlocking nail; plate fixation DOI: http://dx.doi.org/10.3126/hren.v9i2.4974 Health Renaissance 2011: Vol.9 (No.2): 61-66