Nepal Orthopaedic Association Journal

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 Centre

Sun, 31 Dec 2023 00:00:00 +0000

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.

Functional Outcome of Anterior Surgery for Acute Sub Axial Cervical Spine Injury

Sun, 31 Dec 2023 00:00:00 +0000

Introduction: Subaxial cervical spine injuries are common following blunt trauma. Unstable cervical spine injuries are frquently managed with anterior decompression and instrumented fusion. This study aims to measure clinical and radiological outcome of anterior surgery for sub-axial cervical spine injuries done in our center.

Methodology: This was a retrospective analysis of the cases operated from July 2015-June 2019. Patients aged 18-80 years, presenting with subaxial cervical fractures within 7 days of injury with Sub-axial Injury Classification system (SLIC) score more than 3, managed with anterior surgery were included in the study. Outcome was evaluated at 6 months and at one year with Neck Pain Disability Index and Bridewell Interbody Fusion Grading System.

Results: Among 31 patients, ACDF was performed in 14 cases and ACCF in 17 patients. At final follow-up, 43.75% patients had improvement in at least one grade neurology following surgery. Among patients with complete neurological deficit, 25% had minimal disability, 35% moderate, 25% severe and 15% had very severe disability. Similarly, among patients with incomplete neurological involvement, minimal, moderate, severe and very severe disability was seen in 65%, 15%, 20% and none respectively. On average, 90.1% case had grade I fusion, 3.3 % each had grade II, grade III and grade IV fusion. 7 cases had dysphagia which relieved after few days. 1 patient had hoarseness of voice which relieved after few days. Pseudo-arthrosis was seen in 1 case and graft subsidence in 2 cases.

Conclusion: Anterior cervical fusion for acute sub-axial cervical spine injuries gives good clinical and radiological outcome with minimal complications.

Comparison Between Clinical Findings and Magnetic Resonance Imaging Findings in Lumbar Prolapsed Intervertebral Disc

Sun, 31 Dec 2023 00:00:00 +0000

Introduction: Lumbar prolapsed intervertebral disc is commonly associated abnormality with lower backache. Disc herniation of same size can be asymptomatic in one patient and agonizing in another patient. Magnetic resonance imaging (MRI) is a gold standard diagnostic investigation for prolapsed intervertebral disc. Despite of high sensitivity sometimes MRI shows abnormal findings even in the asymptomatic individuals indicating a moderate relationship between MRI and symptoms in the patient. The study was conducted to correlate the abnormalities observed on MRI and clinical features of lumbar disc prolapse.

Methodology: A descriptive cross-sectional study was conducted from 20 December 2021 to 15 September 2022. Ethical approval was obtained from the Institutional Review Committee (Reference number: 078/78-009/HG). A convenience sampling method was used. The study consisted of patients with low back pain and radiation to lower extremity or patient with MRI scan of lumbar spine. Clinical and MRI findings were correlated to know the association and significance of MR findings in producing symptoms.

Results: The study included 68 patients with back pain between 18 to 55 years (mean 41± 8.79 years). Neurological symptoms were present in 26 (38.23%) patients. Disc bulge in MRI was noticed in 48 (45.28%), protrusion in 46 (43.39%) and extrusion in 10 (11.32%) levels, most seen at L5-S1 level (66.11%). The clinical level of pain distribution correlated well with the MRI level (Kappa 0.69), but not all disc bulges produced symptoms.

Conclusion: Clinical features and Magnetic resonance imaging findings of disc prolapse had significant correlation similar to other studies done in a similar setting, but all imaging abnormalities may not have a clinical significance.

Total Hip Arthroplasty in Patients Under 50 Years of Age: A Demo-graphic and Treatment Outcome Study at Five Years Follow-Up

Bibek Banskota, Ansul Rajbhandari, Rajendra Aryal, Ashok Kumar Banskota — Sun, 31 Dec 2023 00:00:00 +0000

Introduction: The indications for a total hip arthroplasty have expanded to younger, higher-demand patients with the advances and availability of durable biomaterials and improved accuracy and surgical techniques of prosthesis implantation. We present our data on the mid-term (five years) follow-up of a cohort of younger patients who underwent THA at our institution.

Methodology: A retrospective study with prospective measurement of functional and patient satisfaction outcomes was conducted for patients under 50 years of age who had undergone a primary THA for any cause from 2010 to 2020. Study variables included demographic profile, etiology, prosthesis details, pre-and post-Harris Hip Scores (HHS), and the short-form SF-12 questionnaire.

Results: Of 206 THAs performed during the study period, 62 (30.09%) THAs met the inclusion criteria. There were 60 patients with 62 hips, including 38 (63.33%) males and 22 (36.67%) females. The mean age was 39.2±7.92 years. The mean pre-operative HHS was 40.10±5.96. The mean follow-up period was 5.14±2.57 years. At the final evaluation, the mean HHS was 90.42±6.35, and SF-12 scores for physical (PS) and mental (MS) domains were 46.98±5.76 and 54.22±4.35, respectively. The HHS was excellent in 45 (72.58%) hips, good in 13 (20.96%) hips, fair in 2 (3.23%) hips, and poor in 2 (3.23%) hips.

Conclusion: Good to excellent functional results were seen in 94% of patients at five years follow-up. Uncemented prostheses and ceramic-on-polyethylene bearing surfaces were preferred.

Functional Outcome of Titanium Elastic Nail Fixation in Diaphyseal Fractures of Forearm in Adolescents

Sun, 31 Dec 2023 00:00:00 +0000

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.

The Outcome of Pediatric Femur Fractures Fixation with Titanium Elas-tic Nail System

Sun, 31 Dec 2023 00:00:00 +0000

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.

Medical errors in Orthopedics: Causes and preventions.

Amit Joshi — Sun, 31 Dec 2023 00:00:00 +0000

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.

A Major Orthopaedic Surgery in a Hundred-year-old Patient During Pandemic of COVID 19: A Case Report

Kapil Mani KC, Raju GC, Bishwash Bhandari, Samir Acharya — Sun, 31 Dec 2023 00:00:00 +0000

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.

Synovial Chondromatosis of Shoulder Treated by Arthroscopic Synovectomy and Removal of Loose Bodies: A Case Report

Sushil Thapa, Sunil Pant, Prasesh Dhakal — Sun, 31 Dec 2023 00:00:00 +0000

Synovial Chondromatosis of the shoulder is mentioned in literature as a rare case. It is a benign neoplastic condition of the synovial membrane. Multiple osteocartilaginous loose bodies inside the joint characterize this rare monoarticular disorder. This case report describes a 32-year-old man who presented with right shoulder pain for six months. He had painful abduction and internal rotation. The condition was diagnosed as synovial chondromatosis. The patient underwent arthroscopic removal of loose bodies and synovectomy. This case illustrates the investigation and treatment of synovial chondromatosis of the shoulder. The loose bodies in synovial chondromatosis of a shoulder joint can be retrieved by arthroscopy as it provides a broader field of vision, better accessible access to the loose bodies, synovectomy, reduced hospital stay, and better rehabilitation.

Tibialis Posterior Tenosynovitis as a First Presenting Feature of Pre-clinical Rheumatoid Arthritis: A Case Report and Literature Review

Sabin Pokharel, Arun Khatri, Rajendra Yonjan, Yam Prakash Gurung — Sun, 31 Dec 2023 00:00:00 +0000

Tenosynovitis in Preclinical Rheumatoid Arthritis (RA) has been reported. The Tibialis posterior (TP) tendon is the second most commonly affected tendon in the foot and ankle in established RA, but in preclinical RA has not been reported.

In this case report, we present a 27 years old lady from Dhading, Nepal, with Preclinical RA with first presentation with Tibialis posterior Tenosynovitis. She was anti-cyclic citrullinated Peptide (CCP) positive but had no arthralgia or morning stiffness. Initial treatment with Non-Steroidal anti-inflammatory drugs failed to alleviate her symptoms. Methotrexate helped improve her symptoms.