Browsing by Author "Shrestha, BK"
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Publication Clinical, MRI and Arthroscopic Correlation in Internal Derangement of Knee(Kathmandu University, 2011) Sharma, UK; Shrestha, BK; Rijal, S; Bijukachhe, B; Barakoti, R; Banskota, B; Pradhan, I; Banskota, AKABSTRACT Background The traumatic or degenerative internal derangement of the knee requires certain investigations for the establishment of diagnosis, in addition to clinical history and a thorough physical examination. The use of arthrography and arthroscopy improves the accuracy of the diagnosis. MRI scanning of the knee joint has often been regarded as the noninvasive alternative to diagnostic arthroscopy. Objective The purpose of the study was to correlate clinical and low field MRI findings with arthroscopy in internal derangement of the knee. Methods Forty one patients with suspected internal derangement of the knee were subjected to MR examination followed by arthroscopy. Clinical criteria used were history, mode of injury, Mc Murray’s, Apley’s grinding, Thessaly’s test for meniscal injury. Drawer test was considered to be essential for clinical diagnosis of cruciate ligament injury. MRI of the knee was performed in low field open magnet (0.35T, Magnetom C, Seimens). Arthroscopy was done within two months of MR examination and was considered gold standard for the internal derangement of the knee. Results The sensitivity, specificity, diagnostic accuracy of clinical examination were 96.1%, 33.3% and 73.1% respectively for medial meniscal tear; 38.4%, 96.4% and 78.1% respectively for lateral meniscal tear. The sensitivity, specificity, diagnostic accuracy of MRI were 92.3%,100% and 95.1% for medial meniscal tear; 84.6%96.4% and 92.6% respectively for lateral meniscal tear. Conclusion Clinical examination showed higher sensitivity for medial meniscal tear compared to MRI, however with low specificity and diagnostic accuracy. Low field MRI showed high sensitivity, specificity, diagnostic accuracy for meniscal and cruciate ligament injury, in addition to associated derangement like articular cartilage damage, synovial thickening. KEY WORDS arthroscospy, knee, MRI.Publication Refractory shoulder pain due to entrapment neuropathy of the suprascapular nerve: a case report(Kathmandu University, 2004) Banskota, B; Bijukachhe, B; Limbu, H; Shrestha, BK; Banskota, AKRefractory shoulder pain of four months duration in a middle aged male proved to be the result of compression of the suprascapular nerve by a large ganglion, demonstrated in the MRI. Surgical removal resulted in the complete relief of symptoms. We present the case report and review the literature. Key words: Suprascapular nerve, compression, ganglion.Publication Study of Working Experience in Remote Rural Areas after Medical Graduation(Kathmandu University, 2014) Thapa, KR; Shrestha, BK; Bhattarai, MDABSTRACT Background Posting of doctors in remote rural areas has always been a priority for Government; however data are scarce in the country about experience of doctors of working in remote areas after medical graduation. Objective A questionnaire survey of doctors was planned to analyze their experience of working after graduation in remote rural areas in various parts of the country. Method The cross-sectional survey was done by convenience sampling method. A one-page questionnaire with one partially closed-end and five open-end type questions was distributed to the doctors who had worked in remote rural areas after graduation under various governments’ postings. Result Two-third of participants had their home in urban areas and 89.8% had stayed for 1 to 5 years. About half of the participants had difficulty in getting the posting in the remote areas of their choice. Most participants indicated provision of opportunities for Residential (postgraduate) Training as their reasons of going to remote areas as well as their suggestions to encourage young graduates to go there. Similarly most also suggested appropriate career, salary and incentives to encourage doctors to go to work in remote areas. About 85% of participants pointed out the major problem faced while posted in remote areas as difficulty in handling varied situations with no guidance or seniors available around. Conclusion The notable points indicated by the participants are centered on the opportunity for Residential Training and difficulties faced without such training. Residential Training is a priority to be considered while planning the health policy for optimum health care of people. KEY WORDS Health service, medical graduate, postgraduate training, remote area health, residential training, rural health, rural retention.Publication Surgical interventions in chronic osteomyelitis(Kathmandu University, 2005) Shrestha, BK; Rajbhandary, T; Bijukachhe, B; Banskota, AKChronic osteomyelitis is a leading cause of morbidity in orthopaedic practice in Nepal. Various factors like health service inaccessibility, inadequate treatment, malnutrition, poverty, and to some extent antibiotic resistance contribute to disease progression from acute osteomyelitis to chronic osteomyelitis in this region of the world. This paper presents our experience of managing ninety patients with chronic osteomyelitis over a period of four years, from February 1998 to November 2001. Key Words: Osteomyelitis, MorbidityPublication Tibial plateau fractures: four years review at B&B Hospital(Kathmandu University, 2004) Shrestha, BK; Bijukachhe, B; Rajbhandary, T; Uprety, S; Banskota, AKBackground: Tibial plateau fractures involve the articular surface of the tibia resulting from a combination of axial loading with varus or valgus stress. Inadequate and inappropriate treatment may result in significant functional loss. Objective: The purpose of this study was to determine the outcome of our treatment modalities and to compare with the results of comparable studies. Methods: The results of treatment of 81 knees were reviewed over the period of five years (1997 to 2002). There were 62 men and 18 women, with an average age of 37 years (15 years to 75 years) at the time of initial evaluation. One patient had bilateral involvement. Fractures were classified according to Schatzker. Seven patients were treated conservatively. Sixteen patients (17 knees, one had bilateral involvement) were operated with closed reduction and percutaneous cannulated screws fixation. Thirty one patients' required open reduction and internal fixation with cannulated screws. Fifteen fractures were plated, and in eleven cases, external fixators were used. Follow up period ranged from six months to three years. Results: Results were graded as excellent, good, fair and poor on the basis of functional outcome. Forty- three (54%) patients (44 knees) had excellent, twenty-two (26%) had good, five (6%) had fair and ten (14%) had poor results. Poor results were associated with high energy fractures, late presentation, and inadequate physiotherapy follow up. Eight patients (10%) had complications. One had common peroneal nerve palsy, six had wound infection and one patient demonstrated early arthritic changes. Conclusion: Tibial plateau fracture is a challenging fracture to manage. Restoration of articular congruity and early range of motion should be the primary goal. Proper and adequate preoperative planning is mandatory. Well maintained articular congruity with stable fixation helps early mobilization and better functional outcome. Key Words: Plateau, Axial load, Varus, Valgus, Articular congruity, Functional outcomePublication Two faces of major lower limb amputations(Kathmandu University, 2005) Paudel, B; Shrestha, BK; Banskota, AKObjectives: To review the indications for major lower limb amputations in adults and children in our patient population and to compare our experience in prosthetic rehabilitation with that of other published information. Material and Methods: We retropectively reviewed charts of patients who underwent amputation between 1997 to 2004 at the Orthopaedic Department of B& B Hospital (BBH ) , Gwarko and Hospital and Rehabilitation center for Disabled Children ( HRDC), Banepa. There were 113 patients at BBH & 89 patients at HRDC . Major amputation was defined as any amputation at or proximal to wrist and ankle. Results: Major lower limb amputations constituted 73.58 %(39/53) of all major amputations at BBH and 97.77% (44/45) at HRDC.Road traffic accident was found to be number one cause for major lower limb amputations (74.29%) in adult population. In children postburn contracture was the leading cause for amputation (29.54 %) folowed by Congenital limb conditions (22.72%) ,Spina bifida with trophic ulcers ( 20.45 %), Tumor (13.63%), Chronic Osteomyelitis (6.81%), Trauma (4.54%) and Arthrogryposis (2.27%). Prosthetic fitting and rehabilitation is as yet far from satisfactory in the adult population but all the children who had amputation at HRDC were fitted with prosthesis. Conclusion: Main causes of major lower limb amputation in both population is largely preventable by instituting safty measures and conducting awareness program. There is a need for an effective prosthetic fitting center for adults. Key Words: Major lower limb amputations, Prosthesis fitting