Browsing by Author "Sharma, V"
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Publication Acetabular Fracture: Retrospective Analysis of Thirty Three Consecutive Cases with Operative Management(Kathmandu University, 2014) Shrestha, D; Dhoju, D; Shrestha, R; Sharma, VABSTRACT Background With the development of better imaging modalities including 3D CT scan and availability of technical expertise, operative management is increasingly performed for acetabular fracture but many patients in developing countries like Nepal, are still being treated with prolonged skeletal traction. Objective To analyses epidemiology, types of acetabular fracture and functional and radiological outcome of patients with acetabular fracture treated with open reduction and internal fixation (ORIF). Method Inpatients hospital records of patients treated with ORIF in between June 2007 to June 2014 were evaluated. Patient’s demographic data, mode of injury, injury hospital interval, injury surgery interval, associated injuries, surgical approach, total hospital stay and peri and post-operative complications were recorded and radiological and functional outcomes were evaluated. Result Thirty three patients (Male: 24 Female: 9) with average age 39 years (range: 21 to 65 years) were operated for acetabular fracture. Twenty one patients (63%) had injury related with motor vehicle accidents and nine (24%) of them had motorbike accidents. Injury hospital interval ranges from 7 to 36 days. Average injury-surgery interval was 21 days and average hospital stay was 22 days. Bicolumnar fractures were found in 15. Nine patients had dislocation of hip and 15 had concomitant other injuries. Biculumanr fixation was performed in 15 patients, posterior column and or wall in nine with Kocher Langenbeck approach and anterior column and or wall in other nine with ilio-inguinal approach. Radiological reduction was anatomical in 18; excellent/good functional outcome was in 26 and radiological outcomes were excellent in 14. Three patients had developed Hypertopic ossification. Follow up period ranged from 6 to 48 months and 15 patients (45%) had follow up >2 years. Conclusion Acetabular fractur can be effectively managed with ORIF and have predictable and comparable functional and radiographic outcomes. Upgrading the existing facilities and training of orthopedic surgeon for acetabular fracture management is important to shorten injury-surgery interval due to lack of such facilities. KEY WORDS Acetabulum, internal fixation, open reductionPublication Allergic fungal sinusitis(Kathmandu University, 2008) Mallick, S; Sharma, V; Lavania, A; Borgohain, BAbstract Allergic Fungal Sinusitis (AFS) is believed to be an allergic reaction of the sinus mucosa to environmental fungi that is finely dispersed into the air. We present a 23 year old man who presented to us with a unilateral nasal mass with foul smelling discharge and headache. Functional Endoscopic Sinus Surgery (FESS) was performed. Microbiology and histopathological examination of the mass confirmed it to be a case of AFS. Key words: Allergic fungal sinusitis, Nasal polyps, FESSPublication Ectopic canine tooth: A rare cause for maxillary antral mucocoele(Kathmandu University, 2006) Sharma, V; Lavania, A; Mallick, SA; Sharma, MA 40-year-old female presented with a 10 year history of left sided facial pain and occasional purulent nasal discharge, refractory to antibiotics. Dental examination showed 3 missing teeth in left maxilla one of which had no history of extraction. X-ray paranasal sinus showed a bony opacity in the maxillary sinus but nasal endoscopy was normal. C.T. scan revealed a radio-opaque shadow arising from medial wall of left maxillary sinus with a large maxillary mucocoele. Caldwell-Luc procedure was done and an ectopic canine tooth was seen arising from the medial antral wall. Extraction of the tooth with excision of mucocoele resulted in relieving of the symptoms. Keywords: ectopic tooth, maxillary mucocoelePublication Intramedullary Nailing for Paediatric Diaphyseal Forearm Bone Fracture(Kathmandu University, 2011) Parajuli, NP; Shrestha, D; Dhoju, D; Dhakal, GR; Shrestha, R; Sharma, VABSTRACT Background Though most of the pediatric diaphyseal forearm bone fracture can be treated with closed reduction and cast application, indications for operative intervention in pediatric both-bone forearm fractures include open fractures, irreducible fractures, and unstable fractures. Controversy exists as to what amount of angulation, displacement, and rotation constitutes an acceptable reduction. Objective To review union time and functional outcome of pediatric diaphyseal forearm bone fracture managed with intramedullary rush pin by closed or open reduction. Methods Fifty patients with both bone fracture of forearm were treated with intramedullary rush pin by closed or open reduction were included in the study and followed up for minimum six months for radilological and functional outcome. Results Out of 50 patients, 31 underwent closed reduction and 19 underwent open reduction. All fractures maintained good alignment post operatively. Forty seven patients had excellent results with normal elbow range of motion and normal forearm rotation and three patients had good results. In all patients good radiological union was seen in three months time. Eight patients had minor complications including skin irritation over prominent hardware, backing out of ulnar pin, superficial skin break down with exposed hardware. Twenty-three (46%) patients had undergone implant removal at an average of 6 months (range 4-8 months) under regional or general anesthesia Conclusion Fixation with intramedullary rush pin for forearm fracture is an effective, simple, cheap, and convenient way for treatment in pediatric age group. KEY WORDS pediatric forearm fracture, rush pinPublication Operative Fixation of Displaced Middle Third Clavicle (Edinburg Type 2) Fracture with Superior Reconstruction Plate Osteosynthesis(Kathmandu University, 2011) Dhoju, D; Shrestha, D; Parajuli, NP; Shrestha, R; Sharma, VABSTRACT Background Conservative management of middle third clavicle fracture has been recently reported with suboptimal outcomes. Despite higher nonunion rates in initial open reduction and internal fixation, understanding the problem better and taking in accounts of previous shortcomings, such fractures can be optimally treated by open reduction and internal fixation with reconstruction plate. Objective To study the outcome of middle third clavicle fracture treated with superior reconstruction plating in terms of function using Constant shoulder score, union time and rate, complications and patient satisfaction. Methods Twenty patients with displaced middle third clavicle fracture (Edinburg type 2) treated with open reduction and internal fixation with reconstruction plate implanted in superior surface were prospectively followed for at least one year after surgery. Results There were 20 patients, 16 males and 4 females. The mean age of the patients was 31.5 years with SD 11.5 years (range 15-60 years) and 5 patients (25%) had associated injuries. All fractures united in 16 weeks or less in near anatomic position with complication in 2 (5%) patients, one deep infection and one frozen shoulder which on subsequent management recovered well. There was no nonunion or implant failure. The average Constant score was 97.45 in one year follow up and the patients were relatively satisfied with the treatment.The most common indication (25%) for hardware removal was young age of the patient, hardware prominence and occasional discomfort Conclusion This small series shows that displaced midshaft clavicle fracture can be optimally treated with operative fixation implanting the reonstruction plate in superior surface with six cortical purchases on either side and supervised physiotherapy, although subsequent surgery for implant removal might be necessary. KEY WORDS middle third clavicle fracture, reconstruction plate.Publication Orbital cellulitis - A complication of sinusitis(Kathmandu University, 2005) Lavania, A; Sharma, V; Reddy, NS; Baksh, RA 9 years old patient presented with swelling and severe pain in right eye with diplopia; with normal visual acuity. CT scan of paranasal sinus revealed right eye axial proptosis and dehiscence in lamina papyracia. After thorough investigation, patient was posted for surgical drainage and decompression of the right orbit. Patient, improved after surgery and followed regularly for last 2 months. Key word: Orbital cellulitis- A complication of sinusitis.Publication Percutaneous Ilio-Sacral Screw Fixation in Supine Position under Fluoroscopy Guidance(Kathmandu University, 2015) Shrestha, D; Dhoju, D; Shrestha, R; Sharma, VABSTRACT Background Pelvic ring disruption when treated conservatively can be associated with prolonged hospital stay and immobilization, mal-union, chronic pain, limb length discrepancy if they are treated conservatively. Open reduction and fixation in an already compromised soft tissue and hemodynamically unstable patient causes more soft tissue injury, heamatoma, infection and neurovascular injury. Percutaneous ilio- sacral joint fixation can be an alternative technique for sacro-iliac joint injury and sacral fracture. Objective To evaluate technique and safety of percutaneous ilio-sacral screw fixation in supine position under single fluoroscopy guidance for sacral fracture and sacro-iliac joint disruption. Method Twenty one patients either with sacral fracture or sacro-iliac joint disruption with percutaneous ilio-sacral screw fixation with cannulated cancellous screw fixation in between 2008 to 2014 were retrospectively evaluated including AP, inlet and outlet views of pelvis X rays and CT scan. Tile’s classification and Dennis classification were used for pelvis and sacral injury. Result Thirty five percutaneous ilio-sacral screws were placed (Male: 6, Female: 15; range: 15 to 54) for sacral fracture involving zone 2 (8 with sacral fracture only and 5 with pelvis injury; Tile’s type B in four and type C in one) and sacro-iliac joint injury (Tile’s type B in three and type C in five). Commonest mode of injury was motor vehicle accidents (10) followed by fall related injury (6). Injury hospital interval and injury surgery interval was five hours to 13 days and 2 to 20 days respectively. Follow period was 3 months to 6 years. One patient developed post-operative deep vein thrombosis and another patient had post-operative haematoma. Two screws were juxtra-foramial. Good to excellent outcome were in 16 patients, fair in four and poor in one patient (Majeed Scoring). Conclusion Percutaneous ilio-sacral screw fixation for sacro-iliac joint injury and sacral fracture with C arm guidance is safe and minimally invasive technique. Clear images and accurate interpretation of X-rays, CT scans and per operative C arm images are important to avoid malpositioning of screws and iatrogenic neurovascular injuries. KEY WORDS Percutaneous screw fixation, sacral fracture, sacro iliac joint injuryPublication Scaphoid Fracture: Functional Outcome Following Fixation with Herbert Screw(Kathmandu University, 2011) Parajuli, NP; Shrestha, D; Dhoju, D; Shrestha, R; Sharma, VABSTRACT Background Most scaphoid fractures though heal uneventfully with cast treatment, immobilization with cast is associated with complication like wrist stiffness. Open reduction and fixation with Herbert Screw though technically demanding procedure can yield excellent results and prevents complication like nonunions and loss of wrist function. Objectives To assess clinical outcome and radiological union of scaphoid fracture after operative management following Herbert screw fixation in patient attending Dhulikhel Hospital. Methods All scaphoid fracture, treated from Feb 2007 till Feb 2011, were retrospectively studied in Dhulikhel Hospital, Kathmandu University Hospital. Fifteen patients with scaphoid fractures were treated with Herbert screw. Fourteen were males and one was female. Serial radiographs were taken to assess radiographic union and functional outcome was assessed using Modified Mayo wrist score. Results Out of 15 patients, 13 scaphoid had waist fractures and two had proximal pole factures. All scaphoid were treated with open reduction and Herbert screw fixation either by volar approach or by dorsal approach. All fractures maintained good alignment post operatively. Nine (60%) patients had excellent results with normal wrist range of motion, five (33.3%) patients had good results and one (6.7%) patient had poor outcome. In 14 (93.3%) patients good radiological union was seen at final follow up at six months time. Conclusion Fixation with Herbert screw for scaphoid fracture is an effective and convenient way of treatment with satisfactory functional outcome and less complication. KEY WORDS scaphoid fracture, Herbert screw, functional outcome