Browsing by Author "Manandhar, RR"
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Publication External and internal fixation for comminuted intra-articular fractures of distal radius(Kathmandu University, 2009) Pradhan, RL; Lakhey, S; Pandey, BK; Manandhar, RR; Rijal, KP; Sharma, SAbstract Background: Distal radius fractures are a common injury and without proper treatment leads to high functional impairment and frequent complications. Objective: The aim of this study was to see the functional outcome in patients with comminuted distal radius fractures treated with combined external fixation and open reduction with volar plating. Materials and methods: All comminuted distal radius fractures classified as type C in AO/OTA classification were enrolled for the study from 2005 till 2008. The clinical scoring chart modified by Cooney was used to evaluate the functional outcome. Results: There were twenty-two patients with the average age of 42.18 years (range 19-60) with 15 male and 7 females. The follow-up period was from 14 to 46 months. Accordingly, there were 11 (50%) excellent, 7 (31%) good, 2 (9%) fair and 2 (9%) poor results. There were very few complications in our series. In three patients additional K-wire supplementation was necessary along with external and open internal fixation. Conclusions: Comminuted intra-articular fractures of distal radius should be treated by open reduction and combined internal and external fixation to achieve a high rate of patient satisfaction and satisfactory functional outcome. Key words: distal radius fractures, volar plating, external fixationPublication Functional outcome of operatively treated displaced intra-articular calcaneal fractures using two parallel contoured reconstruction plates(Kathmandu University, 2010) Lakhey, S; Manandhar, RR; Pradhan, RL; Pandey, BK; Sharma, S; Rijal, KPAbstract Introduction: The treatment of displaced intra-articular calcaneal fracture is controversial. Conventionally, they were treated non-operatively. However, some surgeons are now operatively treating these fractures because of continuing dissatisfaction with the outcome of conservative treatment of these fractures and improvements that have occurred in surgical techniques and complication rates. Objective: The aim of this study was to determine the functional outcome of operatively treated displaced intra-articular calcaneal fractures using two parallel contoured reconstruction plates. Materials and methods: 12 patients with 14 displaced intra-articular calcaneal fractures involving the subtalar joint were included in the study conducted between July 2005 and December 2008. The fracture site was exposed using extended lateral approach. Internal fixation was done by two nearly parallel 3.5mm reconstruction plates and screws contoured to form a gentle curve in all cases with the first plate fixed just below the articular surface. At the end of follow up, the patients' foot function was assessed by Calcaneal Fracture Scoring System of Kerr et al. Patients were also enquired about their satisfaction with their treatment outcome. Results: The patients were followed up for duration of 12 to 24 months (mean 15.64 months). The outcome score as measured by Calcaneal Fracture Scoring System ranged from 48 to 94 (mean 83.64). 11 of 12 patients (91.6 %) were satisfied with the treatment. Conclusion: Displaced intra-articular fractures treated by open reduction and internal fixation, using two nearly parallel, contoured reconstruction plates through an extensile lateral approach and following the principles of treatment of intra- articular fractures, have good functional results with high patient satisfaction rate. Key words: displaced intra-articular calcaneal fractures, operative treatment.Publication Osteosynthesis of intercondylar humerus fracture using bryan and morrey approach(Kathmandu University, 2010) Lakhey, S; Sharma, S; Pradhan, RL; Pandey, BK; Manandhar, RR; Rijal, KPAbstract Background: The olecranon approach has been the gold standard for surgical approaches to fracture fixation of distal articular surface of humerus. Although it provides a good exposure, it also has disadvantages of delayed union, non- union and implant related complications at the osteotomy site. Objective: The aim of this study was to determine the functional outcome of displaced intra-articular distal humerus fracture fixation using an alternative approach: the Bryan and Morrey approach. Materials and methods: Twenty patients with twenty AO type C1 and C2 intercondylar fractures of the distal humerus had bicolumnar fixation of the distal humerus with two contoured reconstruction plates and screws on the dorsal surface or various combinations of a single reconstruction plate, screws and K-wires using a Bryan and Morrey approach. Twelve of the patients were male and eight were female. The average age of the patients was 44.8 years. Eleven patients had sustained the injury as result of fall and nine of the patients had sustained it in road traffic accidents. Right elbow was involved in fifteen patients and left in five. All patients were followed up for 12 months post operatively. Results: All twenty fractures had united at 4 months follow-up. The mean fixed flexion deformity was 9.0º (range 0º- 15º) and the mean arc of motion was 115.0º (range 85º- 130º). All patients had grade 4 triceps strength and stable elbows at the end of 12 months follow up. One patient had deep seated wound infection resulting in necrosis of the triceps tendon requiring a second operative procedure. Conclusions: Bryan and Morrey approach is a simpler, easier and better approach as compared to the other posterior approaches to the elbow joint, and therefore, can be used as the approach of choice for fixation of fractures of the distal articular surface of humerus. Key words: Fracture, Intercondylar Humerus, OsteosynthesisPublication Percutaneous extensor tenotomy for chronic tennis elbow using an 18G needle(Kathmandu University, 2007) Lakhey, S; Mansfield, M; Pradhan, RL; Rijal, KP; Pandey, BP; Manandhar, RRAbstract Introduction: Tennis elbow is a common orthopaedic problem presenting in office orthopaedics, but its exact patho-aetiology has not been identified to date. It is treated operatively when conservative measures including multiple local steroid injections are not helpful to the patients. Material and method: This was a retrospective study to assess the outcome of tennis elbow patients on whom percutaneous release of the common extensor origin was performed using an 18 gauge hypodermic needle. 17 patients with 21 elbows were included in the study. Data was collected by going through the patients’ medical records, and follow –up by questionnaire mailed to the patient’s home, to assess the outcome and patient satisfaction with the procedure. Results: 14 of the 21 (66.7%) elbows became completely pain free. The time taken to achieve a completely pain free elbow ranged from 1 day to 3 months (average 60.3 days). Those that did not achieve a pain free elbow had a residual pain of 1.5 to 8.5 on the VAS (average 2.64). 9 elbows (42.9%) had an excellent outcome, 7(33.3%) had good, 4(19%) had satisfactory and 1(4.8%) had poor outcomes. Conclusion: Tennis elbow probably results from degenerative tear of common extensor origin and a percutaneous tenotomy using an 18 gauge hypodermic needle is a simple, safe, patient friendly, effective and easily reproducible method of treating it in those who require surgery and can be done as an office procedure. Key words: Tennis elbow, percutaneous tenotomy, 18g hypodermic needlePublication Sub-trochanteric fractures of the femur: Results of ORIF at KMCTH(Kathmandu University, 2007) Rijal, KP; Manandhar, RR; Pandey, BKSub-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.