Browsing by Author "Baral, P"
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Publication Dorsal Metacarpophalyngeal Dislocations of Thumb in Children-Clues to the Clinical Decision Making and a Dorsal Approach to Open Reduction(Kathmandu University, 2018) Baral, PABSTRACT Dorsal Metacarpophalyngeal joint dislocation of thumb in children is a rare occurrence. All the three different types, namely Simple Complete, Complex Complete and Incomplete dislocations have been described in this article with clinical and radiological clues to differentiate the closely reducible (simple) dislocations from irreducible ones (complex). A simple approach to treatment decision making has been adopted for all cases, starting with attempt of closed reduction which if fails, moving to open reduction. First case is a simple dorsal dislocation presenting after fall injury with hyperextension deformity of thumb Metacarpophalyngeal joint that was reducible by closed maneuver. Second case presented with pain and inability to move thumb Metacarpophalyngeal joint, with less marked deformity than the first case. Closed reduction failed and open reduction was done with dorsal approach to the metacarpophalyngeal joint joint after volar plate interposed in the metacarpophalyngeal joint was pushed anteriorly. Third case was an incomplete dorsal dislocation that was reduced closed. Dorsal metacarpophalyngeal dislocation of thumb in children is rare injury. Diagnosis needs a high index of suspicion ascomplex dislocation can be missed due to less obvious deformity. Dorsal approach to open reduction of complex dislocation is a direct and reliable approach. KEY WORDS Dislocation, Joint, Metacarpophalyngeal, Volar platePublication How to uphold standards of medical education in Nepal: Some recommendations(Kathmandu University, 2009) Baral, PNAPublication Multiple arterial anomalies in upper limb(Kathmandu University, 2009) Baral, P; Vijayabhaskar, P; Roy, S; Kumar, S; Ghimire, S; Shrestha, UAbstract An isolated neurovascular variation is common but multiple vascular anomalies on same upper limb is a very rare case. We observed an unusual variations in right upper limb during routine dissection of a Nepali cadaver . The variations were observed in Axilla, Forearm and Palm. In axilla, first part of axillary artery did not give any branch, the second part of axillary artery gave off only two branches - (a) thoracoacromial artery and (b) a large common trunk which later gave off lateral thoracic, thoracodorsal, subscapular, posterior circumflex scapular and then continued as posterior circumflex humeral artery. The third part of axillary artery gave off only anterior circumflex humeral artery. In forearm, the ulnar artery runs downward superficial to flexor muscles. Here, radial artery gave off common interosseous artery. In palm radial artery did not give any contribution to superficial palmar arch which is solely formed by the continuation of ulnar artery. This type of anomalies are very rare and is not reported in Nepalese cadaver at all. These anomalies are described in detail and their clinical relevance is highlighted. Key words : Axillary artery, Brachial artery, Radial artery, Ulnar artery, Palmar arch, VariationsPublication Radiological Assessment of Femoroacetabular Impingement Morphology Using Computed Tomography in Asymptomatic Young Population(Kathmandu University, 2025) Koirala, S; Gupta, MK; Baral, P; Adhikari, KABSTRACT Background Femoroacetabular impingement is regarded as precursor of osteoarthritis. Various studies have discussed the prevalence of femoroacetabular morphology but only few studies have been done on asymptomatic population using cross-sectional imaging. Objective To determine the prevalence of femoroacetabular impingement morphology in young asymptomatic population on computed tomography. Method This cross-sectional study was done in 200 individuals who underwent computed tomography for abdominal pathologies without any symptoms of hip pain, hip pathology or osteoarthritis. Multiplanar images were reformatted and assessed for the presence of parameters associated with femoroacetabular impingement; alpha angle greater than 55°, femoral head-neck offset less than 8 mm, angle of acetabular version less than 15°, lateral center edge angle greater than 40°. Result At least one of the femoroacetabular impingement morphology was detected in 162 hips. The prevalence of abnormal hip joint was higher in male patients than in female patients (47.3% vs 31.8%). Prevalence of cam morphology was 14.5%, pincher was 17.5% and mixed morphology was 8.5%. Prevalence of cam and mixed morphology were common in male hips however there was no statistically significant difference in prevalence of pincher morphology between male and female hips. Conclusion Femoroacetabular morphology was noted with high frequency in asymptomatic young population on computed tomography. Diagnosis of femoroacetabular impingement syndrome should be based on combination of clinical and radiological findings. KEY WORDS Alpha-angle, Cam, Femoroacetabular impingement, PincherPublication Supernumerary head of biceps brachii: A rare occurrence in the Nepalese population(Kathmandu University, 2008) Vijayabhaskar, P; Baral, P; Vaishya, R; Shrestha, RNAbstract Unilateral three headed biceps brachii muscle was observed in the dissected cadaver of a 45-year-old Nepalese cadaver. The supernumerary head is taking origin from the tendon of deltoid and crossing in front of the long head of biceps and joining with short head of biceps brachii. The incidence of this variation is very rare and there was no available literature in Nepalese population. Presence of such variation should be kept in mind by Surgeons and Traumatologists. Key words: Biceps brachii muscle, Supernumerary head