Nepal Orthopaedic Association Journal最新文献

{"title":"C-reactive Protein and Erythrocyte Sedimentation Rate Levels in Chronic Low Back Pain Patients","authors":"Saurav Dahal","doi":"10.59173/noaj.20241001c","DOIUrl":"https://doi.org/10.59173/noaj.20241001c","url":null,"abstract":"Introduction: Lumbar disc degenerative disease, intervertebral disc herniation, lumbar stenosis, and arthritis are usual causes of chronic nonspecific low back pain. Patients with acute lumbosciatic pain usually have elevated levels of inflammatory markers such as highly sensitive C-reactive protein. However, studies that analyze the levels of Erythrocyte sedimentation rate and C-reactive proteins in patients with chronic low back pain are insufficient. Hence, this study aimed to assess the value of these markers for the determination of inflammation in patients with chronic low back pain. Method: A cross-sectional, hospital-based, observational study was conducted after receiving ethical approval from the Institutional Review Committee. The study started on Feb 20, 2023, and lasted till Aug 10, 2023. Statistical analysis of the level of inflammatory markers was done by evaluating their mean values. Results: 120 patients who presented with nonspecific chronic low back pain were evaluated clinical-radiologically and sent for blood investigations. The mean erythrocyte sedimentation rate was 11.54 mm/h, and the mean C-reactive protein level was 5.90 mg/L. Blood sedimentation rate was found to have a significant positive correlation with increasing age and female sex. Conclusion: Chronic nonspecific low back pain does not elicit a systemic inflammatory response, as evidenced by normal ESR and CRP levels. Keywords: Blood Sedimentation; C-Reactive Protein; Low back pain","PeriodicalId":233960,"journal":{"name":"Nepal Orthopaedic Association Journal","volume":"8 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141795592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Functional and Radiological Outcomes of Double Endobutton Fixation for Acute Acromioclavicular (AC) Joint Dislocation","authors":"Jyoti Sitaula","doi":"10.59173/noaj.20241001b","DOIUrl":"https://doi.org/10.59173/noaj.20241001b","url":null,"abstract":"Introduction: There are various surgeries described in the literature for acromioclavicular (AC) joint dislocation. These surgeries have their own advantage and disadvantages. We routinely practice the double endobutton technique for acute AC joint dislocation for Rockwood type III-VI injuries. The aim of this study was to evaluate the functional outcome using the University of California, Los Angeles (UCLA) Shoulder Rating Scale and also assess the biomechanical stability coracoclavicular distance (CC) distance radiographically. Methods: This was a prospective observational study done in twenty-five patients selected by convenience sampling method. The double endobutton was made using two 4.5 mm endobutton and fiber wire. The clavicular tunnel and coracoid tunnel were made, the endobutton was flipped underneath the coracoid, and the construct was tightened and secured. Results: The functional outcome was measured using the University of California and Laos Angle Shoulder rating scale (UCLA), which showed an average score of 30.24. The score was excellent in 80%and fair in 20% of the cases. The radiological outcome was measured using CC distance, and a comparison was made between uninjured and injured limbs, which was not statistically significant (p=0.57). The immediate postop CC distance was compared in one year, which also did not show any statistical significance difference (p=0.074). Conclusion: AC joint repair using double endobutton had excellent functional outcomes and radiological outcomes. Keywords: Acromioclavicular Joint; Coracoclavicular Distance; Endobutton.","PeriodicalId":233960,"journal":{"name":"Nepal Orthopaedic Association Journal","volume":"29 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141795340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medical errors in Orthopedics: Causes and preventions.","authors":"Amit Joshi","doi":"10.59173/noaj.20230902j","DOIUrl":"https://doi.org/10.59173/noaj.20230902j","url":null,"abstract":"While Nepal faces unique challenges in the healthcare system, including limited resources and geographical barriers, there have been notable developments in orthopedics. The number of orthopedic surgeons has significantly increased. Hence, orthopedic services are now available in all the corners of the country. Orthopedic interventions are now provided even in remote areas with the establishment of government and private hospitals. With the increase in health care delivery, even in resource-limited regions of the country. Medical errors have also increased.","PeriodicalId":233960,"journal":{"name":"Nepal Orthopaedic Association Journal","volume":"76 23","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139132035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Outcome of Pediatric Femur Fractures Fixation with Titanium Elastic Nail System","authors":"Devendra Acharya","doi":"10.59173/noaj.20230902i","DOIUrl":"https://doi.org/10.59173/noaj.20230902i","url":null,"abstract":"Introduction: Pediatric femur fractures are commonly present because of high-velocity injuries in children. It is the most common reason for pediatric hospital admission due to trauma. There is a spectrum of choices for fixation for these fractures, but the best method has always been debated. In this study, we share our experience of fixation of pediatric diaphyseal femur fractures at our center using Titanium Elastic Nail System. Method: A hospital-based prospective study was conducted between January 2019 to June 2022. Patients aged between 5 to 12 years with shaft of femur fracture and body weight of less than 49 kg were included in the study. Children with pathological fractures, ipsilateral limb injuries, metabolic bone disease, and neuromuscular disorders were excluded. All patients were followed up till nine months with radiographic and clinical assessment. Result: A total of 47 children were included in this study. The mean age was 8.08±2.17 years, and the mean weight was 26.55±6.46 kg. Postoperatively the mean union time was 11.36 weeks, whereas the mean time for full weight bearing was 9.70 weeks. Two (4.25 %) patients had transient superficial wound infection. Four (8.51%) patients had skin irritation due to nail tips, and five (10.63%) patients had more than 1cm of limb length discrepancy. Limb malalignment >10 degrees was noted in two (4.25%). At the end of nine months, 70.21% reported excellent, 25.53% satisfactory, and 4.25% poor outcomes as per Flynn’s criteria. Conclusion: Titanium Elastic Nailing System is a minimally invasive pediatric femur fracture fixation method with relatively few associated complications and predictable favorable outcomes. Keywords: Diaphyseal, Pediatric femur fracture, Titanium Elastic Nailing System","PeriodicalId":233960,"journal":{"name":"Nepal Orthopaedic Association Journal","volume":"61 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139132638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Functional Outcome of Titanium Elastic Nail Fixation in Diaphyseal Fractures of Forearm in Adolescents","authors":"K. Kandel","doi":"10.59173/noaj.20230902g","DOIUrl":"https://doi.org/10.59173/noaj.20230902g","url":null,"abstract":"Introduction: This study aims to assess the functional outcomes of Titanium Elastic Nailing System (TENS) fixation for managing diaphyseal forearm fractures in adolescents. Method: The study was a prospective clinical study conducted at B.P. Koirala Institute of Health Sciences Between December 1, 2020, and November 30, 2021. Ethical clearance was obtained from the Institutional Review Committee (Registration Number 305/077/078-IRC). A total of 27 patients who underwent TENS fixation for forearm diaphyseal fractures were included. Patients were followed at 2 weeks, 6 weeks, 12 weeks, and 24 weeks. Radiological and functional outcome evaluations were assessed, including the range of motion, deformity, and time taken for union and active recovery. Collected data were entered in Microsoft Excel and converted to SPSS (Statistical Package for Social Sciences) version 28 for statistical analysis. Results: Among 27 included patients, 66.7% were males, 81.5% were within the age group of 10-13 years, 70.4% fell on outstretched hands, and 66.7% had fractures at the middle third of the forearm. Union was seen in 6 weeks among 29.6%, 12 weeks among 66.6%, and 24 weeks among 3.8%—7.4% developed complications. Conclusion: TENS is an effective fixation method for diaphyseal forearm fractures in adolescents and provides satisfactory functional outcomes. Keywords: Adolescents; Forearm bone fractures; Functional outcome; TENS","PeriodicalId":233960,"journal":{"name":"Nepal Orthopaedic Association Journal","volume":"26 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139131351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fungal Infection of Pelvis : an Uncommon Cause for Low Backache","authors":"Daman Kumar Jha","doi":"10.59173/noaj.20230901j","DOIUrl":"https://doi.org/10.59173/noaj.20230901j","url":null,"abstract":"This study reports a case of 43 years male with low back ache which on investigation proved to be due to cryptococcus fungal infection of ilium which is an uncommon cause of low backache. The focus of infection was evacuated, and the bone debrided along with administration of anti-fungal drugs. On follow up of 9 months after surgery and antifungal treatment, the patient had no symptoms and there was regression in size of the lesion in the left iliac bone. Key Words: Cryptococcus, Fungal infection, Low back ache,","PeriodicalId":233960,"journal":{"name":"Nepal Orthopaedic Association Journal","volume":"103 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117135802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiological Assessment of Distraction Osteogenesis of Large Bone Defect in Lower Extremity Long Bone: A Descriptive Study","authors":"S. P. Barnawal","doi":"10.59173/noaj.20230901g","DOIUrl":"https://doi.org/10.59173/noaj.20230901g","url":null,"abstract":"Introduction: Bone defect is difficult to manage. Objective of this study was to assess radiological parameters of distraction osteogenesis of large long bone defects. Methods: Descriptive study was carried out in department of orthopedics, Jawaharlal Institute of Postgraduate Medical Education and Research Pondicherry, India during April 2018-March 2019. Inclusion criteria were bone gap of more than 5cm either in tibia or femur, skeletal maturity, bone defect due to trauma or excision of tumor; and bone transport by either by Ilizarov or linear reconstruction system. Patients with incomplete data, poly-trauma, and brain injury were excluded. A senior orthopedic surgeon performed all surgeries. Well-trained orthopedic surgeons collected data. Outcome variables were bone union, primary bone length, length of bone gap, implants type, duration of apparatus, number of days of distraction, percentage of transport, distraction speed and bone healing index. Results: Mean age of participants was 33.8 years. All of them were males. Road traffic accident was cause for bone loss in 80 % of cases. Bone union was attained in all patients. Bone loss of up to 15 cm was gained by distraction osteogenesis. Range of bone gap was from 5.38 cm to 15 cm. 6.9 to 17.66 months were required for complete union and removal of fixator. Up to 46 % of bone transport was possible with Ilizarov. Two patients were treated with additional intramedullary nail. Conclusion: Distraction osteogenesis can achieve union in large bone defect up to 15 cm in tibia and femur. Additional internal fixation with an intramedullary nail can be beneficial. Key Words: Bone union, distraction osteogenesis, large long bone defect","PeriodicalId":233960,"journal":{"name":"Nepal Orthopaedic Association Journal","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117136157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Missed scaphoid fracture: Diagnostic difficulty and treatment dilemma.","authors":"K. Kc","doi":"10.59173/noaj.20230901i","DOIUrl":"https://doi.org/10.59173/noaj.20230901i","url":null,"abstract":"Scaphoid is the most common carpal bone to be fractured, accounting for approximately 15% of all wrist fractures. Most important aspect in managing such fractures is the inability to achieve accurate diagnosis, especially when these fractures are un-displaced, minimally displaced, or occult in nature. There is a lack of knowledge regarding such injuries among first responders, especially at primary and secondary care set up of our country. Majority of such injuries are missed in initial evaluation and result in scaphoid non-union, which are difficult to manage and result in functional disability. Detailed physical examination, including, anatomical snuff box tenderness, volar distal tuberosity tenderness, or positive scaphoid compression test (sensitivity 70.5% and specificity 21.8%) along with appropriate radiographic assessment are essential to reach the correct diagnosis and commence the treatment early. The aim of this study is to highlight the challenges and discuss the potential solutions in managing patients with occult scaphoid fractures. Key Words: Health workers; Missed fractures; Nonunion; Orthopedic surgeons; Scaphoid fractures.","PeriodicalId":233960,"journal":{"name":"Nepal Orthopaedic Association Journal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129699636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Semitendinosus Tendon Autograft Length and its Correlation with Anthropometric Measurements in Patients Undergoing Arthroscopic Anterior Cruciate Ligament Reconstruction using Hamstring Tendon Autograft in a Tertiary Care Centr","authors":"I. Pradhan, Subhash Regmi","doi":"10.59173/noaj.20230902a","DOIUrl":"https://doi.org/10.59173/noaj.20230902a","url":null,"abstract":"Introduction: There is limited data available regarding semitendinosus tendon length and its correlation with anthropometric parameters in Nepalese population. This study aims to find out mean semitendinosus tendon length in patients undergoing arthroscopic anterior cruciate ligament reconstruction and its correlation with patient’s height, femur length, and thigh girth. Methodology: An observational study was conducted following institutional review committee (IRC) approval (reference number: B&BIRC-23-04). All Patients undergoing arthroscopic anterior cruciate ligament reconstruction using hamstring tendon autograft between January 1, 2021, and December 31, 2022, were included. Those who had premature rupture of semitendinosus tendon during graft harvest were excluded. Semitendinosus tendon autograft was harvested, and length was measured. Then, triplicated graft diameter was measured. If harvested gracillis, quadrupled or pentapled, combined semitendinosus and gracilis tendon autograft diameter was measured. Pearson’s correlation coefficient was used to evaluate correlation and student t test was used to test the significance. Results: Out of 102 included patients, 87(85.3%) were male and 15(14.7%) were female. Mean age of the patients was 30.5 ± 8.4 years. Semitendinosus tendon alone autograft was used in 26(25.5%) cases. and combined semitendinosus and gracillis tendon was used in 76(74.5%) cases. Mean semitendinosus tendon autograft length was 27.9±2.8 cm. There was significant positive correlation between semitendinosus tendon autograft length and patients’ height (r= 0.594, p=.000) and femur length (r=0.528, p=.000). Conclusion: Mean semitendinosus tendon autograft length in patients undergoing arthroscopic anterior cruciate ligament reconstruction is comparable to what reported in other international studies. Semitendinosus tendon length is significantly positively correlated with patients’ height and femur length.","PeriodicalId":233960,"journal":{"name":"Nepal Orthopaedic Association Journal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130168222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Major Orthopaedic Surgery in a Hundred-year-old Patient During Pandemic of COVID 19: A Case Report","authors":"K. Kc","doi":"10.59173/noaj.20230902d","DOIUrl":"https://doi.org/10.59173/noaj.20230902d","url":null,"abstract":"It has been undoubtedly assumed that COVID-19 imposes an immense economical and psychological trauma to all common people. It is also true that COVID-19 had been appeared like a “world war” for health care workers all over the world. However, either conservative or operative treatment were offered for all trauma patients even during that period. We report a 100 years old female patient with femoral shaft fracture who was treated with intramedullary interlocking nail with full precautions to prevent virus transmission during lock down period. The post and perioperative complications were uneventful, and she was walking comfortably after surgery. Keywords: COVID 19; Femoral fracture; Lock down; Pandemic","PeriodicalId":233960,"journal":{"name":"Nepal Orthopaedic Association Journal","volume":"78 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123350192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}