Browsing by Author "KP, Rijal"
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Publication Acute sacrococcygeal dislocation (anterior type): A case report(Kathmandu University, 2004) KP, Rijal; RL, Pradhan; S, Sharma; S, Lakhey; BK, PandeySacrococcygeal dislocation is a rare injury. A twenty-nine year old male presented to us with pain over the lowest part of spine of 5 days duration. He fell down on stairs with his buttock landing directly over the edge of the stairs. On examination, a step was felt in the continuity of sacrum and coccyx. The tip of the coccyx was not palpable. Per rectal examination revealed a small bump on running the finger along the sacrococcygeal curvature. On plain radiographs of sacro-coccygeal region, lateral view revealed anterior dislocation of the coccyx over the sacrum. On antero-posterior view, the injury could not be identified. Under general anaesthesia, an attempt to reduce the dislocation per rectally was tried, but failed. The patient was treated conservatively with analgesics. He refused surgery, as he was relieved of pain with analgesics. Key Words: - Sacrococcygeal dislocation, coccydynia, conservative treatment.Publication Pre-operative assessment of K-nail length in fracture shaft of femur(Kathmandu University, 2006) S, Lakhey; RL, Pradhan; M, Bishwakarma; S, Pradhan; S, Pradhanaga; BK, Pandey; KP, RijalIntroduction: Internal fixation of diaphyseal fracture of shaft of femur in an adult by Kuntscher nail is the most common operative method of treatment in Nepal where operative facilities for the same exist. Since the complete range of K-nail sizes and length are not available in most operation theatres in Nepal, most orthopaedic surgeons assess the size and length of the K-nail pre-operatively by various methods and keep one size above and below the assessed length for the planned surgery. Materials and Methods: The following measurements were taken in five hundred people involved in the study: Measurement No. 1: Tip of the greater trochanter to lateral knee joint line minus 2cms. Measurement No. 2: Tip of the olecranon process to the tip of little finger, and Measurement No. 3: Tip of the greater trochanter to the upper pole of patella. An average of all three lengths were analysed to see if there were any differences in their mean lengths. Results: Analysis showed that there were significant differences between the mean lengths measured by the three different methods. The average length of measurement no: 2 was 3 cm longer than the average length of measurement no: 1, which is the reference pre-operative length of K.nail. Conclusion: However, in practice since measurement no:2 is more convenient to perform and can also be used when the patient has sustained bilateral fractures of femur, an accurate pre-operative K-nail length assessment can be done by subtracting 3 cm from measurement no:2, i.e. the tip of the olecranon process to the tip of the little finger.Publication Reduction of Acute Anterior Shoulder Dislocations under Local Anaesthesia – A Prospective Study(Kathmandu University, 2004) K, Paudel; RL, Pradhan; KP, RijalObjective: To evaluate the application of local anaesthesia for reduction of acute anterior shoulder dislocation Design: A prospective study of patients coming with anterior dislocation of shoulder to KMCTH from July 2002 to Sep 2003. Subjects: Patients of aged 15-55 years with no associated fractures of adjoining bones. Results: A total of fifteen patients with anterior inferior shoulder dislocation were studied and all were reduced safely under local anaesthesia. Conclusion: Use of intra-articular lignocaine for reduction of shoulder dislocation is safe and effective and is beneficial for countries like Nepal where health facilities are minimum in rural and suburban areas. Key words: Shoulder dislocation, intra-articular injection, local anaesthesia, reductionPublication Sub-trochanteric fractures of the femur: Results of ORIF at KMCTH(Kathmandu University, 2007) KP, Rijal; RR, Manandhar; BK, PandeySub-trochanteric fractures of the femur are not commonly encountered as compared to trochanteric or neck of femur fractures. Relatively younger persons are injured more and a considerable violence is required for this fracture to occur. These fractures, treated conservatively by methods like traction, splints or casts, are often associated with complications like non-union, mal-union, shortening of the limb etc. Thus, we undertook this study of 10 consecutive cases of sub-trochanteric fractures of the femur treated by open reduction and internal fixation and bone grafting in Kathmandu Medical College Teaching Hospital, Sinamangal, from the year Nov. 2000 to April 2006. There were 4 females and 6 male patients. Their age on average was 46.8 years (range 15 to 86 years). Most of the patients were in Type II or III in Seinsheimer classification; Type II A, B, and C, one, two and one respectively, and in Type III A and B three patients each. Seven patients were treated with dynamic hip screw. Three patients with type III were managed with centro-medullary interlocking nail with one cerclage suture. They were followed for a period of minimum 6 months to 6 years (average 3.5 years). Union was achieved in all, on an average 4 months postoperatively. Results were excellent and complications like nonunion, malunion or breakage of the implants, were not encountered in any patient.Publication Supracondylar extension type III fracture of the humerus in children: Percutaneous cross-pinning(Kathmandu University, 2006) KP, Rijal; BK, PandeyObjective: Supracondylar extension type III fractures in children are difficult to treat especially in maintaining reduction after closed manipulation, thereby increasing chances of complications. Materials and methods: Forty consecutive patients with supracondylar extension type III fracture of the humerus attending Kathmandu Medical College Teaching Hospital (KMCTH) between July 2004 to December 2005, treated by closed manipulative reduction and percutaneous cross-pinning under general anaesthesia, were the subject of this prospective study. Results: There were 16 females and 24 males. The mean age of the patients was 6.5 years (2 to 12 years). Left side was injured in 27 patients and right side in 13. Patients were followed for a period of one year on average (6 to 18 months). Under general anaesthesia and C-arm image intensifier, closed manipulative reduction was performed. Two K-wires of size 1.6 to 2.0 mm were introduced from lateral and medial side in crossed fashion. Ulnar nerve was protected by pushing it posteriorly during medial pinning. Long arm plaster slab was applied post-operatively. Patients were discharged the next day of operation. Callus was visible in all patients on X-rays after 3 weeks. The long arm slab and K-wires were removed and active mobilization of the elbow joint was started. Fracture union was seen in all, 6 weeks post-operatively. At follow-up, range of motion of the elbow joint was 25 to 135 degrees after 6 weeks and 0 to 140 degrees after 3 months, which was similar to that of normal side. After 3 months of operation carrying angle was 8 – 10 degrees in all except in two cases (0 degree). There were no neuro-vascular complications or cubitus varus deformity in any of the patients. Conclusion: Percutaneous crossed K-wire pinning after closed manipulation in supracondylar extension type III fracture of the humerus is a reliable and safe method of treatment and is recommended in all.