In urban areas of Nepal, RTAs like vehicular crashes, motor cycle accidents, and pedestrian hit by moving vehicle are more common and in rural areas fall from height are commoner. We need to develop child safety legislations and risk-specific intervention programs in Nepal.

Introduction: Supracondylar fracture of humerus is one of the common pediatric fractures encountered in our daily clinical practice. The purpose of this study is to determine the pattern of supracondylar fracture operated at rural teaching hospital of Jumla, Karnali Nepal. Methods: A descriptive cross sectional study was conducted at Jumla, Karnali after Institutional Review Committee approval. Operating room notes from 15 May 2017 to 16 November 2019 were retrieved to gather the following information: patients address, age, sex, side, injury mechanism, displacement, neurovascular injury, concurrent injuries, initial management by traditional bone setters, time between injury and surgery, operative technique. Data analysis was done using Statistical Package for Social Sciences version 20. Results: A total of 138 children underwent operative fixation with mean age of 7.47 years and gender ratio of 2:1 boy to girl. Fall from cliff, ladders and rooftops were the prevailing cause of injury 72 (52.8%). Left side predominated with 88 (63.7%) and extension type was common in 135 (97.8%). Thirteen (9.4%) patients were initially managed by traditional bonesetters. Average time between injury and surgery was 5.2 days. Closed reduction was done in 100 (72.4%) patients whereas open reduction was necessary in 38 (27.5%) patients. Conclusions: Closed extension type pediatric supracondylar fracture was common in this study. Fall from cliff, rooftop and ladder are the major cause of fracture. Delayed presentation and initial management of the fracture by the traditional bonesetters makes supracondylar fracture more challenging in resource limited setting like ours.  

<p class="abstract"><strong>Background:</strong> Pediatric forearm bone fracture present significant challenges where most of them are managed with closed reduction and casting. Irreducible, unstable and open fracture usually requires operative stabilization. Intramedullary nailing is considered minimal invasive however it is not free of complication. The aim of this study is to analyze the outcome and complications after elastic stable intramedullary nailing in pediatric diaphyseal forearm fracture<span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> A descriptive observational study was carried out for four years (2013-2016) in diaphyseal pediatric forearm fracture stabilized with titanium elastic stable intramedullary nailing. Final range of motion, complications and outcome were assessed using Clavien-Dindo classification modification appropriate for orthopedic surgery.<strong></strong></p><p class="abstract"><strong>Results:</strong> We report the outcome of 36 patients with complete medical records. Closed reduction and nailing was successful in 25 patients (69.4%) whereas eleven patients (30.6%) required open reduction (both radius and ulna in 6 patients 16.7%, ulna in 3 patients 8.3% and radius in 2 patients 5.6%). Radiological union was achieved at an average of 7.75±1.5 weeks (range 6 to 16 weeks). Forearm rotation was limited in 7 patients with average loss of 16° pronation and 18° supination. The overall rate of complication was 22.2%. According to Clavien-Dindo classification excellent results were noted in 29 patients (80.6%), good in 3 patients (8.3%) and fair in 4 patients (11.1%)<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> Elastic intramedullary nailing in pediatric diaphyseal forearm bones fracture is minimally invasive with low rate of complication and the outcomes are fair to excellent<span lang="EN-IN">.</span></p>

Background: Chronic unreduced dislocation of elbow is a rare injury. Treatment options include open reduction internal fixation with K wire, replacement arthroplasty, excisional arthroplasty, arthrodesis, and hinged external fixator. The aim of this study is to determine the outcome of open reduction internal fixation with trans-olecranon K wire for neglected elbow dislocation. Methods: This is a retrospective study done in three rural hospital of Karnali. Hospital records were reviewed from July 2015 to May 2018 to identify 11 cases who underwent open reduction internal fixation for neglected elbow dislocation. Pre and Postoperative outcome was assessed using range of motion and Mayo Elbow Performance Index. Data analysis was done using SPSS version 17. Results: The average age of patient was 22.7 years (range 9-50 years). Non dominant hand was involved in 54.55%. The average preoperative elbow extension was 5.9 degree whereas postoperative extension was 15.9 degree. The average preoperative and postoperative elbow flexion was 24.5? and 113.6? respectively. Preoperative and postoperative Mayo elbow performance index was 18.6 and 86.3 respectively. Outcome was excellent in four patients, good in five patients and fair in two patients with one case having superficial infection. Conclusions: Open reduction and internal fixation with trans-olecranon k wire is an effective treatment method for neglected elbow dislocation. Postoperatively, elbow function is better with minimal complications. Keywords: Dislocation; elbow; neglected; open reduction

Background & Objectives: Pediatric forearm bone fractures are common orthopedic injuries. Generally, these fractures can be successfully managed with closed reduction and casting however operative fixation may be required. Currently, the most common operative interventions are open reduction with plate fixation versus closed or open reduction with intramedullary fixation. Intramedullary fixation materials include Steinmann pins, Kirschner-wires, Rush pins, and elastic titanium nails. To demonstrate the outcome of Intramedullary Stainless steel Rush pins for the treatment of Pediatric diaphyseal forearm bone fracture.Materials & Methods: This study included thirty children with diaphyseal forearm bone fracture treated with intramedullary stainless steel rush pin. Patient’s age, sex, side, mode of injury, fracture type, fixation indication and method, time of clinical and radiological union, complication rate and final range of motion were evaluated at subsequent follow up­. Clinical evaluation was done as per Price’s criteria. Results: Among 30 patients there were 22 boys (73.3%) and 8 girls (26.6%) with a mean age of 11.8 years (Range, 5 to14 years). Twenty (66.6%) patients had right forearm fracture, 10 (33.3%) patients had left forearm fracture. Union was obtained in a mean of 6.5±1.0 weeks (range 6 to 9 weeks). According to the criteria of Price et al. an excellent result was achieved in 25 patients (83.3%) and a good result in five patients (16.6%). Out of total 30 patients six (20%) had minor complications. Conclusion: Fixation with intramedullary stainless steel rush pin produces good to excellent results in diaphyseal forearm bone fractures in children. Based on our experience, rush pins are simple, safe, easily available and affordable to most of the patients in developing countries.JCMS Nepal. 2016;12(2):50-4