Browsing by Author "Mahara, DP"

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    Accuracy of Lelli Test For Anterior Cruciate Ligament Tear
    (Institute of Medicine, 2015) Thapa, SS; Lamichhane, AP; Mahara, DP
    Abstract Introduction: The anterior cruciate ligament (ACL) is an important stabilizer of the knee. Rupture of the ACL, unfortunately, is a common sports injury. Three most accurate test routinely applied in clinical practice to determine ACL injuries are the Anterior drawer, Lachman, and pivot shift tests test .In this study we evaluate the accuracy of Lelli test for detecting ACL tear and compare it with those tests. Methods: This study included 80 patients attending sports clinic at Department of orthopedics, Tribhuvan University, Teaching Hospital from December 2013 to November 2014, aged between 20-45 years with knee symptoms of giving way/locking/pain following sports or non sports injury .Clinical history and detail clinical assessment of knee for instability including Anterior drawer test, Lachman test, Pivot shift test ,Lelli test were performed by standard technique and recorded in the Performa. All patient underwent knee arthroscopic evaluation and needful procedure by an experienced arthroscopic surgeon. Arthroscopy findings of ACL tear was recorded and used to assess the reliability of clinical test. Results: In this study sensitivity of Anterior drawer test, Lachman test , Pivot shift test , Lelli test was 80.00%(CI 62.53-90.93),91.42%(CI 75.81-97.75) ,51.42%(CI 34.27-68.27), 85.71%(CI 68.95-94.61) respectively and Specificity was 93.33%(CI 80.68-98.28), 95.55%(CI 83.36-99.22), 100%(CI 90.20- 100.00) , 91.11%(CI 77.87-97.11) respectively. Conclusion: Lelli test being simple test can be routinely used in evaluation of ACL function in both acute and chronic knee injury. Keywords: Anterior drawer test, Lachman test, Pivot shift test, Lelli test
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    Comparison Between Hydroplasty and Intra-articular Steroid Injection in Treatment of Idiopathic Frozen Shoulder
    (Institute of Medicine, 2014) Dhungana, DP; Lamichhane, AP; Mahara, DP
    Abstract Introduction: Idiopathic frozen shoulder is one of the common problems in orthopedic outpatient department. It is characterized by gradually progressive pain and stiffness of the shoulder followed by spontaneous recovery over the period of time.Many different modalities are available for the treatment of Idiopathic frozen shoulder, but no one is universally accepted. The purpose of this study was to compare the outcome of hydroplasty with intra-articular steroid injection. Methods: This was a comparative hospital based study conducted between March2011 to September2012, which included 50 patients with Idiopathic Frozen shoulder. There were 25 patients in each group. The mean age of respondent was 57.36 years. Simple Random method of sampling was adopted for selecting patients for each group. Hydroplasty group was given 30ml chilled(cold) sterile normal saline with 2 ml Methylprednisolone (80 mg), 4 ml 2% Lidocain(plain) and 4 ml 0.5% Bupivacain (total volume:40ml) and steroid group was given 2ml Methylprednisolone, 4ml 2% Lidocain(pain), 4ml 0.5% Bupivacain with total volume: 10 ml. Both groups were attached for therapeutic exercises. Comparison of outcomes between two treatment groups was done using Visual Analogue Scale (VAS) for pain, Shoulder Pain and Disability Index for Shoulder function and degree of range of motion. Statistical analysis was done using SPSS 17.0 Results: There was significant improvement in level of pain, Shoulder function (Shoulder Pain and Disability Index) and range of motion in forward flexion, abduction, external rotation, and internal rotation in three month period in Hydroplasty group compared to Steroid group. Conclusion: There was improvement in pain, range of movement and Shoulder Pain and Disability Index (SPADI) score in all patients of both group but the difference in improvement was found to be statistically significant in hydroplasty group as compared to steroid injection group. So Shoulder hydroplasty technique was found to be more effective treatment modality than intra-articular steroid injection in idiopathic frozen shoulder. Keywords: frozen shoulder, hydroplasty, intracular steriod injection, shoulder pain anddisability index
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    Functional outcome of single bundle anatomical anterior cruciate ligament reconstruction using either quadruple hamstring or bone patellar tendon bone graft by medial portal technique
    (Institute of Medicine, 2018) Thapa, SS; Neupane, P; Lamichhane, AP; Mahara, DP
    Abstract Introduction: The anterior cruciate ligament (ACL) is the most frequently injured knee ligament. Abnormal knee kinematics in ACL deficient knee causes early osteoarthritis. Single bundle anatomical ACL reconstruction by medial portal technique provides better knee stability then transtibial technique. Many studies suggests that there is no difference in outcome of ACL reconstruction using hamstring or bone patellar tendon autograft. In this study we evaluated functional outcome(based on mean Lysholm score) at 6 month of single bundle ACL reconstruction by medial portal technique using bone patellar tendon bone or quadruple hamstring graft Methods: This was a prospective longitudinal study on functional outcome(using Lysholm score) of 75 patients who underwent single bundle anatomical ACL reconstruction by medial portal technique by using either quadruple graft hamstring or bone patellar tendon bone graft in sports and arthroplasty unit in Tribhuvan University teaching hospital, Kathmandu, Nepal between March 2014 to February 2016. Mean Pre op and 6 month postop Lysholm score of two groups was compared using paired-t test to evaluate the functional outcome of the surgery. Results: In this study overall mean preop Lysholm score was 48.48±6.50 (36-62) and 6 month postop Lysholm knee score was91.58±3.10 (85-95), with p value 0.0000. The mean preop and post op Lysholm score for Quadruple hamstring group was 47.7 and 91.5 respectively, while that for bone patellar tendon bone group was 54 and 91.7. Conclusion: The functional outcome (based on mean Lysholm score) at 6 month postop of single bundle anatomical ACL reconstruction was similar irrespective of type of graft used. Keywords: Anterior Cruciate Ligament (ACL), Lysholmscore, Medial Portal technique
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    Injury Epidemiology after 7.8 Richter Gorkha Earthquake in Nepal: A Retrospective Study of Injuries Treated at Tribhuvan University Teaching Hospital
    (Institute of Medicine, 2018) Thapa, SS; Lamichhane, A; Mahara, DP
    Abstract Introduction: Earthquakes are one of the most catastrophic natural disasters that occur without prewarning, Nepal experienced a massive earthquake of 7.8 Richter scale on 25th April 2015.It claimed 8,962 lives across several districts in Nepal with 22,302 injuries. After the earthquake, hospitals are confronted with large number of disaster trauma victims making it challenging for management of such mass casualty. Despite such crisis Tribhuvan University Teaching Hospital (TUTH) provided all possible services round the clock to all disaster victims brought to hospital from very first hour after the earthquake. Methods: This is a retrospective analysis of management of the injured patients admitted in TUTH after the Gorkha earthquake. Patient’s details including demographic data, injuries sustained and treatment carried out was retrieved from medical record section of the hospital. Injury pattern were categorized broadly into orthopedics related and non-orthopedics injure. Frequency distribution of these data’s was calculated using Microsoft excel. Results: Out of 1812 earthquake related injuries treated in hospital, 493 injured cases required admission. Their mean age was 35.84±21.84 years. Of them 153(31.6%) cases were from Kathmandu and 133 (27.0%) from Sindhupalchowk and Ramechhap.364 cases had single injury and 129 cases had multiple injuries, 81% of the injuries were orthopedic related and 19 % were non-orthopedic injury. Out of them 361(73.2%) cases required surgery, 119 (24.1%) were managed conservatively, 13(2.6%) died. Conclusion: Earthquake is the most unpredictable catastrophic natural disaster. Limb fractures and soft tissue injuries are most common among the injury survivors. Knowing the nature and epidemiology of the injuries will help in effective management of available resources for benefit of maximum number of victims. Keywords: Earthquake, Orthopedics, Tribhuvan University Teaching Hospital (TUTH)
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    Neglected Medial Hoffa Fracture for 9 years -A Case Report
    (Institute of Medicine, 2016) Thapa, SS; Lamichhane, A; Mahara, DP
    Abstract Hoffa fractures, coronal fractures of the femoral condyle, are uncommon injuries. It is often missed on initial plain radiographs. Medial Hoffa fractures are three times less common then lateral Hoffa. Here we present a case of neglected non-union of medial Hoffa fractures for 9 years, with good outcome after Open reduction and internal fixation. Keywords: Hoffa fracture, Non-union
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    Pretibial Cyst after Anterior Cruciate Ligament Reconstruction with Non-bioabsorbable Interference Screw
    (Institute of Medicine, 2018) Thapa, SS; Lamichhane, A; Mahara, DP
    Abstract Pretibial cyst formation after anterior cruciate ligament reconstruction is a rare late complication. Exact etiology is not known, but it is commonly reported with use of bioabsorbable screw for fixation. Here we report a very rare case of pretibial cyst after anterior cruciate ligament reconstruction even with use of non-bioabsorbable screw for fixation. Keywords: Anterior cruciate ligament (ACL), Pretibial cyst, Titanium screw

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