Browsing by Author "Karmacharya, Mahesh"
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Publication Clinical and Radiological Outcome of Anterior only Stabilization for AO Type B And C Subaxial Cervical Spine Injury: An Observational Study(Nepal Medical Association, 2025) Subedi, Ram Sharma; Hamal, Bhadra; Baral, Kabita Devi; Rijal, Badri; Karmacharya, Mahesh; Sah, Prem Kumar; Dhakal, Gaurav RajAbstract Introduction: AO type B and C subaxial cervical spine injuries are highly unstable and require surgical fixation for the stabilization. This study aims to determine their outcome after anterior stabilization clinically and radiologically. Methods: This was an observational longitudinal study conducted at tertiary level trauma center, from March 2021 to April 2022 after ethical approval from Institutional Review Board (Reference Number: 665/2077/78). Based on inclusion criteria total sampling was done. Cervical spine injuries AO type B and C operated with anterior cervical stabilization were included. Descriptive statistics were used to analyze data. Results: Among 21 total cases, 14 (66.67%) were male and 7 (33.33%) were female with the median age of 40 (IQR 32-51) years. Eleven (52.38%) patients sustained AO type B injury and 10 (47.61%) patients sustained AO type C injury. The commonest mode of injury was fall from height 14 (66.66%) followed by RTA 6 (28.57%) and physical assault 1 (4.76%). Postoperatively there was 33% improvement in incomplete neurology by one grade on ASIA neurology. Pain was evaluated using Visual Analogue Score and disability was evaluated using Neck disability Index scoring with the median value of 2 (IQR 0.4-3) and 10 (IQR 3-13) respectively. Radiographic failure was present in 2 (9.52%) patients. Forteen (66.66%) patients showed Grade 1 fusion, six (28.57%) showed Grade 2 fusion, and one (4.76%) showed Grade 3 fusion.. Conclusions: Most of the patients experienced mild pain and disability, stable fusion and low rate of radiographic failure with no new neurological deterioration. Almost half of the injuries occurred at the level of C5-C6.Publication Driving Under the Influence of Alcohol among Road Traffic Accident Patients Presenting to a Tertiary Care Centre(Nepal Medical Association, 2023) Joshi, Pramod; Karmacharya, Mahesh; Shrestha, Sailendra Kumar DuwalAbstract Introduction: Driving under the influence is one of the most significant risk factors for road traffic accidents, leading to severe and multiple orthopaedic injuries. The aim of this study was to find out the prevalence of driving under the influence of alcohol among road traffic accident patients presenting to a tertiary care centre. Methods: A descriptive cross-sectional study was conducted on patients involved in road traffic accidents presenting to a tertiary care centre. Data from 10 January 2020 to 9 December 2021 were collected between 22 July 2023 to 22 August 2023 from the hospital records after receiving ethical approval from the Institutional Review Committee. Patients who had road traffic accidents and were diagnosed with fractures were included in the study. Patients with incomplete hospital records were excluded from the study. Convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Results: Among 2,519 patients, 307 (12.19%) (10.91-13.47, 95% Confidence Interval) were driving under the influence of alcohol when involved in a road traffic accident. Out of 307 patients, 305 (99.35%) accidents involved two-wheelers. A total of 118 (38.44%) patients suffered soft tissue injuries, while 47 (15.31%) sustained head injuries, and 28 (9.12%) sustained facial injuries. Conclusions: The prevalence of driving under the influence of alcohol among road traffic accident patients presenting to a tertiary care centre was similar to other studies done in similar settings.Publication Functional Outcome of Single-Stage Reconstruction for the Multi-Ligament Injuries of the Knee(Nepal Health Research Council, 2024) Hamal, Bhadra; Karmacharya, Mahesh; Bhattachan, Sijan; Hamal, Pawan KumarBackground: Multi-ligament injuries of the knee are rare injuries that can cause significant impairment of the knee function. There is controversy in the treatment regarding staged versus single-stage surgery. This study was performed to assess the outcome of the single-staged reconstruction of the multi-ligament injury of the knee. Methods: This prospective observational study was done from January 15, 2022 to January 14, 2023. The outcome was analyzed by comparing the preoperative and 12-month postoperative Visual Analog Scale score, Lysholm Score, and International Knee Documentation Committee Score. Results: The mean age of the patients was 28.35 years. among 12 patients 9 were male and 3 were female. Single-staged multi-ligament reconstruction was done in all the cases. The Lysholm score was improved from preoperatively 36.42 ± 1.46 to 95.36 ± 2.84, IKDC score was improved from 24.38 ± 1.64 to 93.86 ± 3.14, VAS score 8.14 ± 1.44 to 0.40 ± 0.60 at 12 months postoperative follow-up which all came to be clinically significant with p-value < 0.001. Conclusions: Single-stage multi-ligament reconstruction of the knee is an effective method of treatment and has excellent outcomes. Keywords: Multi-ligament injury; reconstruction; single-stage.Publication LIMP Score and Anterior Cruciate Ligament Injury in Patient Undergoing Arthoscopy for Acute Knee Injury: An Observational Study(Nepal Medical Association, 2025) Karmacharya, Mahesh; Sherchan, Binod; KC, Bikash; Subedi, Ram Sharma; Rijal, Badri; Koju, Saphalata DeviAbstract Introduction: Globally, anterior cruciate ligament injury is common but difficult clinical diagnosis in acute setting because of pain during examination and difficult availability of investigations and diagnostic arthroscopy. Legs giving way, Inability to continue the task, Massive effusion and pop sound heard at the time of injury or LIMP score is a history based scoring which can be aid to diagnose anterior cruciate ligament injury. This study is designed to find out the proportion of patient with LIMP score of >2 having anterior cruciate ligament injury. Methods: An observational cross-section study was done among the patients visiting emergencies and out patient department of respective hospitals after approval from Institutional review Committee (Reference number: 23/2078/79). The LIMP score was assessed during the presentation and patients were followed up at arthoscopy for the final diagnosis. Results: There were 126 patients enrolled in the study among which 68 (54%) had LIMP score of >2. Out of the total, 74 (59%) had anterior cruciate ligament inury among which 67 (90.5%) had LIMP score >2. Among the patient who did not have anterior cruciate ligament injury, 51 (98%) had LIMP score <2. Conclusions: The proportion of patients having anterior cruciate ligament injury were higher in the category with LIMP score >2.Publication Orthopaedic Fractures among Patients Attending a Tertiary Care Centre(Nepal Medical Association, 2023) Joshi, Pramod; Karmacharya, Mahesh; Shrestha, Sailendra Kumar DuwalAbstract Introduction: Orthopedic fractures caused by chronic metabolic bone disease, overuse, or road traffic accidents are among the most significant burdens on society. Furthermore, a growing number of people undergoing arthroplasty and an increase in life expectancy seem to contribute to an increase in orthopaedic fractures. However, research on orthopaedic fracture prevalence or types has been scarce in low- and middle-income countries, including Nepal. The objective of this study was to find out the prevalence of orthopaedic fractures among patients attending a tertiary care centre. Methods: A descriptive cross-sectional study among patients attending a tertiary care centre was conducted between 19 May and 18 November 2023 during which date from 1 January to 30 December 2021 were collected from the hospital records. Ethical approval was obtained from the Institutional Review Committee. A convenience sampling method was used. Point estimate was calculated at a 95% Confidence Interval. Results: Among 7609 people, 2518 (33.09%) (12.97–10.55, 95% Confidence Interval) had orthopaedic fractures. A total of 1925 (76.45%) were males. There were 339 (95.49%) fractures associated with two-wheelers and 307 (86.48%) with four-wheelers. There were 1387 (55.08%) soft tissue injuries, 198 (7.86%) skull injuries, and 116 (4.61%) facial injuries. Additionally, there were 73 (2.90%) fractures of the femur, 71 (2.82%) fractures of the phalanx, and 70 (2.78%) fractures of the clavicle. Conclusions: The prevalence of orthopaedic fractures was found to be higher than in other studies done in similar settings.