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Medial epicondyle fracture associated with incarcerated intra‐articular fragment and ulnar nerve palsy is uncommon and frequently missed. We report a case of 13‐year‐old boy with incarcerated medial epicondyle fracture fragment in ulnohumeral joint and ulnar nerve palsy, which was managed successfully by open reduction internal fixation and ulnar nerve transposition.

Study Design: Epidemiological retrospective study. Objective: To describe the demographics, timing to surgery, delay, short-term neurological recovery, and complications in surgically treated subaxial cervical trauma in a resource-constrained country. Methods: Thirty consecutive subaxial cervical trauma patients presenting to a trauma hospital in Nepal between December 2015 and August 2017 were analyzed as a retrospective cohort. Patients were segregated into 4 groups based on the timing to surgery: within 2 days, 3 to 7 days, 8 to 30 days, and >31 days. Results: There were 27 male and 3 female patients with mean age 40 years. Twenty-four sustained fall injury, and 27 patients were from outside Kathmandu. No patients were treated within the first 48 hours; only 9 were treated between 3 and 7 days, 16 between 8 and 30 days, and 5 a month later. Major delay was finance and operating room availability. Thirteen patients had a C6C7 involvement followed by C5C6 in 6 patients. Seven patients had complete neurological deficit while 18 patients had incomplete deficit. A total of 46.7% improved their neurology in 6 months. No neurological recovery was observed in complete deficit patients. Conclusion: Seventy percent of our patients were treated longer than 1 week after injury, which would likely be considered unacceptable in most first world countries. As expected, the outcomes for many of these patients were far worse than reported in North American centers with early access to medical care and insurance. Despite this, nearly half of our patients improved neurologically following treatment; hence, surgery holds hope of some restoration of neurologic deficits.

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.

INTRODUCTION: Appendicular lump is a well known sequalae of acute appendicitis encountered in 2-6% of patients. Successful management of appendicular lump is controversial with different approaches. As many controversies are arising regarding management of appendicular lump. The aim of this study was to find out the outcome and evaluate possible need of changing our management strategy of appendicular lump. METHODS: A retrospective analysis of the patients managed with appendicular lump were done. All the patients admitted with diagnosis of appendicular lump and managed between, over two and half years, were included in the study. All age groups and both sex were included. Any patients whose diagnosis was changed after initial diagnosis of appendicular lump were excluded from the study. RESULTS: Total 75 patients had appendicular lump suggesting 10% incidence. Age varied between 11-83 years with nearly equal incidence in both sexes. Majority had onset of symptoms between 2 to 14 days with an average of 4 days. Average stay was 3 to 4 days. During study period, 12 (16%) came with recurrence and 13 (17%) cases came for elective appendectomy. CONCLUSIONS: Based on our finding, it is not sufficient to change our classical management strategy of appendicular lump and suggests a need for long term prospective study in this very common clinical condition. KEYWORDS: appendicular lump, conservative management.

Surgical complications of typhoid fever are uncommon and usually when it occurs, it commonly involves gut than the gallbladder. We present a case report of 20years old gentleman who presented with ten days duration of fever and one day history of sudden severe generalized pain abdomen. Patient was evaluated and investigated and undergone laparotomy in the line of peritonitis. Operative finding was gallbladder perforation and he underwent cholecystectomy. Other investigations were supportive of typhoid fever. Patient improved and was discharged after seven days. Key words: gallbladder, perforation, typhoid DOI: 10.3126/jnhrc.v7i1.2295 Journal of Nepal Health Research Council Vol. 7, No. 1, 2009 April 52-53