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Introduction: Orthopaedic surgical activity has been significantly affected by COVID-19 pandemic. The decision to perform operative interventions is based on balancing risk to benefit to the patient and health care workers. Though different guidelines have been published, there is a lack of reliable data on orthopaedic surgical activities. Our study aimed to evaluate the impact of the COVID-19 pandemic on Orthopaedic surgeries comparing with the previous year. Methods: This was an epidemiological retrospective comparative study conducted at Shree Birendra Hospital, Nepal after taking ethical approval from the Institutional Review Committee of NAIHS. Data of the first four month of orthopaedic surgeries after National lockdown (from March 24 to July 23, 2020) and the same four month period of the previous year (The year 2019) were retrieved. The demographic profiles and operations categories (trauma, elective and infections) were compared between two periods using SPSS 21. Result: Out of total of 651 patients enrolled, 169 patients operated during the pandemic compared with 482 patients before the pandemic. There was a 65% reduction in total surgical procedures, 94% reduction in elective cases and trauma cases were reduced by 29% (P < 0.05). Implant removal (107, 42.8%) constituted the highest elective cases in the year 2019. Conclusions: The orthopaedic surgical procedures were decreased in frequency during COVID-19 because of a decrease in elective cases. The total trauma patients remained more equable during pandemic despite strict lock-down. Health care facilities should consider this during post pandemic recovery.

Introduction: Knee injuries are common among active adults. Achieving a correct clinical diagnosis is often difficult in acute presentations. Knee arthroscopy is considered the gold standard in diagnosing post-traumatic intra-articular lesions, but it is an invasive procedure requiring a certain degree of expertise. Magnetic Resonance Imaging (MRI) is a non-invasive, sensitive diagnostic tool for knee injuries. This study aims to correlate the findings of MRI with arthroscopy of the knee. Method: This Prospective Observational Study was done at Shree Birendra Hospital, Kathmandu, Nepal from 13 Feb 2016 to 13 Jun 2016. The sensitivity, specificity, and accuracy of MRI findings in ligamentous, meniscal, and osteochondral injuries of the knee were analyzed using arthroscopic findings as standard. Result: Fifty-two patients (35 male and 17 female), mean age 35.4 years were included in the study. The accuracy of MRI for anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial meniscus, lateral meniscus, and chondral lesions of the knee were 94%, 100%, 92%,86%, and 86% respectively. Conclusion: The MRI is accurate (86-94%) in diagnosing Meniscal and Ligamentous injuries of the knee. It has poor sensitivity (22%) for chondral lesions.

Introduction: Implant removal surgery is one of the common surgical procedures done in orthopedics. Studies report that a major portion of orthopedic surgeries carried out in different institutions comprises implant removal procedures. This can be challenging in limited manpower and infrastructure availability scenarios, like in developing countries like Nepal. This study aims to study the prevalence of orthopedic implant removal procedures carried out among overall surgical procedures in the orthopedic department of a tertiary care center in Nepal. Methods: A descriptive cross-sectional study was performed on the medical records of the department of orthopedics of a tertiary care center after approval from the institutional review committee. The data included records from the starting of 2018 to the end of 2019. Data related to the number of implant removal procedures, types of implants, indications, fracture sites, anesthesia use, gender and age distribution were studied. Statistical Package for Social Sciences version 20 was used to study descriptive data. Results: Out of 2557 orthopedic operations carried out in the study duration, 458 (17.91%) of implant removal procedures were done in the department. The most common age group was the young adult age group, 255 (55.68%). Medium-sized implants were the commonly removed ones, 337 (73.58%). Elective procedures were the most common indication, 369 (80.57%). Conclusions: Implant removal procedures cover a major fraction of overall orthopedic operations carried out by the department, most of which are elective procedures. In limited-resource settings, this can be challenging, and a proper evaluation with counseling could be done before implant removal surgery.

Calcific tendinitis occurs frequently in shoulder and hip region. Its occurrence in elbow joint is frequently misdiagnosed because of its rare incidence and similar clinical presentation with other acute conditions of elbow like trauma, infection and tennis elbow. Characteristic symptoms of this condition are acute onset of pain, tenderness and swelling on the lateral aspect the elbow. Plain Radiograph is the primary modality to distinguish and evaluate this condition. Awareness and familiarity with this condition helps in early diagnosis and avoids unnecessary treatments and biopsy as this condition is self-limited.Keywords: Calcific tendinitis; self-limited; tennis elbow.

Fracture of Patella is rare and constitutes almost 1% of all skeletal injuries. Bilateral fracture of patella is even rarer accounting for 2.9% of all patella lesion. Very few cases of bilateral patella fractures have been reported in literature. We report the rare case of bilateral patella fracture in a healthy female and discuss the management challenges. doi: http://dx.doi.org/10.3126/mjsbh.v13i1.13005

Osteoid Osteoma is benign bone forming tumor commonly occurs in lower limbs. Osteoid Osteoma of upper limb is rare, and it is extremely rare in hands. We report a case of a 20 year old male who presented with complaints of pain in nail bed of left little finger over a period of one year with gradually increasing swelling and deformity of nail. Radiological examination revealed a well-defined lytic lesion with sclerotic margin at distal phalanx with a nidus at center. Curettage and removal of nidus was done under digital nerve block. He was symptom free from next day of surgery and the tip of the finger has significantly regained its original shape over a period of two years. The aim of this paper is to report yet another uncommon case of osteoid Osteoma located at distal phalanx of little finger.Medical Journal of Shree Birendra Hospital; July-December 2012/vol.11/Issue2/46-49 DOI: http://dx.doi.org/10.3126/mjsbh.v11i2.7911

Introduction: Joint replacement surgery, has become one of the most frequent prosthetic surgeries over the past decades due to its success in restoring function to disabled arthritic individual. A two-stage revision arthroplasty is a well-accepted method for the treatment of a deep infection of a hip with a joint implant. In the present study, the results of three infected hips with the interim use of an indigenous cemented prosthesis along with gentamycin impregnated cement beads were assessed with a two stage revision. Methods: Three consecutive patients who were managed with a two-stage revision hip arthroplasty for the treatment of a previous infection, with retained implants, were followed clinically and radiographically for an average of 15 months. Following removal of implants and debridement (first stage), an indigenous medicated prosthesis along with antibiotic coated cement beads were implanted, for an interim phase of six - eight weeks aft er which a new prosthesis was placed ( second stage ).In this period antibiotics ( both intravenous and oral) were administered to the patients. Results: In a mean follow up period of 15 months, there is no evidence of recurrent infection in all three patients, as of now. The use of antibiotic coated cement prosthesis along with gentamycin mixed cement beads was associated with a satisfactory hip score, and better walking capacity in the interim period, a lower transfusion requirement at the time of reimplantation, and no postoperative dislocation. Conclusions: Locally prepared medicated spacer and gentamycin coated beads help in eradicating hip infection, besides being more cost effective. Medical Journal of Shree Birendra Hospital; Jan-June 2012/vol.11/Issue1/32-36 DOI: http://dx.doi.org/10.3126/mjsbh.v11i1.7765

Introduction: Stress fractures are common during military training but femoral neck stress fractures are uncommon and sometimes pose diagnostic and therapeutic challenges. An incomplete stress fracture with excellent prognosis, if left unprotected, can lead to displaced femoral neck fracture with almost 63% complication rate even with best of the treatment. The aim of this study was to analyze various aspects of the femoral neck stress fracture so that early diagnosis can be made to prevent devastating complications like osteonecrosis and non-union. Methods: The four year army hospital record of 16 patients with femoral neck stress fracture were studied. Their demographic profi le, type of fracture, presentation delay, on set of clinical symptoms and complication of femoral neck stress fracture were critically analyzed. Results: The mean age of the patient was 19.94 years. Total 74% of them developed fi rst symptoms of stress fracture between four to seven weeks of training. There was 3.4 weeks delay from the clinical onset of symptoms to the diagnosis of stress fracture. The type of femoral neck stress fracture were compression (31.25%), tension (18.75%) and displaced (50%). Out of eight displaced type of fractures, 5 (62.5%) had developed complications (3 osteonecrosis and 2 nonunion). Conclusions: Femoral neck stress fracture occurs in initial four to seven weeks of training. The high index of suspicion in initial period of training can help to detect and decreases significant morbidity. Key Words: displaced stress fractures, non-union, osteonecrosis, recruits

Introduction : Shoulder dislocation is common injury requiring urgent reduction. For the reason that patient is not nill orally and anesthetists are not available, reduction under intra venous anaesthesia is not possible. This study was aimed to evaluate the effectiveness of intraarticular lidocaine and stimson’s technique of shoulder dislocation, which could be performed without anesthetist and irrespective of nill orally status. Methods: A prospective observational study was performed from December 2009 to December 2010. Under all antiseptic precautions 20 ml of Lidocaine was injected intraarticularly and reduction was performed by Stimson’s technique. Visual Analogue Score, time for reduction and failure to reduction by this technique was recorded. Results: Out of 27 dislocations 22 were successfully reduced and remaining required added scapular manipulation. The mean VAS scor was 2.3±1.26 and the mean time of reduction was 17.96±1.9 minutes. Conclusion: Stimson’s method with Intraarticular Lidocaine is effective, safe, less costly and can be performed in periphery where anesthetist and monitoring facilities are not available. DOI: http://dx.doi.org/10.3126/mjsbh.v10i1.6406 Medical Journal of Shree Birendra Hospital Jan-June 2011 10(1) 6-8