Browsing by Author "Singh, GK"
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Publication Polyarticular tuberculosis in a young boy: A rare presentation(Kathmandu University, 2007) Bajracharya, S; Nepal, P; Singh, MP; Singh, GKPolyarticular tuberculosis involving bilateral hip and bilateral knee joints without obvious pulmonary or disseminated form of tuberculosis in a young boy is presented along with literature review.Publication Predicting cubitus varus in supracondylar fractures of the humerus by Baumann’s angles in post reduction X-rays(Kathmandu University, 2006) Dahal, M; Kumar, P; Singh, GK; Arora, SS; Singh, MPObjectives: The present study presents the technique to predict cubitus varus by post reduction Affected Side and Normal Side Baumann’s angle difference (ASBA and NSBA) respectively. It intends to correlate the Baumann’s angle to the final carrying angle of the injured elbow and presents the relevant mathematical clinical rule along with its prediction test characteristics. Material and Methods: Total 57 patients of 6.5±1.67yrs, 22 were males and 8 females with 19/30 having left side injury. Isolated closed supracondylar fractures of humerus up to 5 days duration included and previous trauma, pathological fracture, other injury, elbow disease were excluded .30/57 completed >1 year follow-up. Results: The Mean NSBA was 74.4±4.14º. The mean normal side carrying angles (NSCA) were 9.56 ± 2.2º. The NSCA IQR (Inter Quartile Range) was 8.8-10º. The ASBA was 79.9±9.1º and affected side carrying angles (ASCA) was 0.20±8.7º. The ASCA was best predicted by the difference between ASBA-NSBA (ASCA=3.87-0.65(ASBA- NSBA; F=15.91). At a cut off of 8.8º (the lower limit of IQR for NSCA), a value >0º for ASBA- NSBA was 80% predictive of cubitus varus. With pre test probability of varus at 70%, sensitivity was 0.94 and specificity 0.42. Discussion: A prediction rule to predict the final carrying angle from ASBA NSBA difference is presented with a positive predictive value 0.80, specificity of 0.42, and sensitivity of 0.94 at a pre test probability of 0.70.When the diagnosis of cubitus varus is ASCA<8.8º (Lower limit of the IQR for NSCA). Conclusion: If affected side Baumann’s Angle – Normal Side Baumann’s Angle is equal to or greater than 0 then there was 80% probability of having cubitus varus. Key words: Supracondylar fractures of humerus, Baumann’s angle, Complications, Carrying angle, Cubitus Varus.Publication Role of rehabilitation centres in reducing drug abuse problem in a town of Eastern Nepal(Kathmandu University, 2006) Niraula, SR; Chhetry, DB; Singh, GK; Nagesh, S; Shyangwa, PMObjectives: This paper focuses to describe the role and activities of Drug Rehabilitation Centres (DRCs) in reducing the drug-abuse problem in Dharan. It also offers suggestions for increasing the effectiveness of prevention programs. Materials and methods: Records of three DRCs working in Dharan for the past 9 years were analyzed using appropriate statistical tools. Results: The yearly clean rate is significantly higher in these centres. Harm reduction program was currently available only in one centre. Pharmacotherapy along with short-term rehabilitation was available at de-addiction unit of B. P. Koirala Institute of Health Sciences whereas long-term rehabilitation was at others centres. Conclusion: Thus, there should be a strong coordination and network with each other to increase the effectiveness of the treatment program for drug abuse. The treatment centres should be increased in number as well as in quality. BPKIHS should take initiation to start long-term management with repeated booster programs. Key words: Role, rehabilitation, drug abuse, BPKIHS, Dharan, Nepal.Publication Treatment of grade IIIB opens tibial fracture by ilizarov hybrid external fixator(Kathmandu Unviversity, 2007) Kumar, P; Singh, GK; Bajracharya, SObjective: We evaluated the results of patients who were treated with Ilizarov hybrid external fixator for type IIIB open tibial fractures. Materials and methods: 35 Gustilo grade IIIB tibial fractures of age between 18 to 42 years (22 male and 13 female) in which 12 distal fourth tibia (D/4) of C1.1 (6), C1.3 (6), 12 upper fourth Tibia (U/4) of A2 (8) and A3 (4) according to AO classification and 11 Tibial plateau fractures of Schatzker type VI (5) , V(5), IV(1) . All tibial plateau, proximal fourth fractures and lower fourth fractures of tibia and fibula (Reversed Hybrid), treated with Ilizarov hybrid fixator using two Ilizarov 5/8 rings and AO External fixator were followed up to 12-52 months. Results: D/4 fractures were united at 31.1667±8.3046 wks, U/4 at 24.00±5.2915 and Tibial plateau at 15.545±4.160 weeks (p-0.00). ROM in tibial plateau type IV 130°±00, type V 124°±8.94° , type VI 125°±7.0711°, D/4 of type C1.1 (50°±0.00), type C1.3 (43° ±5.7755) whereas full ROM in U/4 fractures. Pin tract infection occurred in 21% of cases. Pain on walking in 20% of cases of type VI tibial plateau fractures and 80% of cases of type IV and V. Problem free in rest of parameter of function of VI and 100% problem in IV and V. Pain at rest observed in 20% of cases in type V. In 66.67% U/4 fractures had pain on walking but no other functions were compromised. In 33% D/4 fractures of C1.1 type had pain on walking only and had 1cm of shortening. Conclusion: On the basis of our experience, we suggest adopting this method for functional limb salvage after extensive complex high-energy injuries. This fixator is safe and versatile, effective in providing stability and allowing early rehabilitation, although the indications for its use are very relatively specific. Key words: Ilizarov hybrid external fixator, tibial plateau, upper fourth and distal fourth fractures, Clinical and Functional outcome.Publication Treatment of supracondylar fracture of the humerus (type IIB and III) in children: A prospective randomized controlled trial comparing two methods(Kathmandu University, 2008) Pandey, S; Shrestha, D; Gorg, M; Singh, GK; Singh, MPAbstract Background: Consensus on method of treatment of displaced supracondylar fracture of the humerus in children is still lacking. Purpose of this prospective randomized controlled study is to compare closed reduction and long arm slab application with closed reduction and percutaneous crossed Kirschner wires xation. Materials and methods: Children of age less than 12 years presented in B.P. Koirala institute of health sciences, Dharan in one year were randomly allocated to group A and group B consisting 30 patients in each group. Closed reduction and long arm posterior slab was applied in group A and in group B, closed reduction was followed by crossed Kirschner wires xation. Clinical and radiological evaluation of reduction was performed immediately after procedure and at the end of rst week, third week, third month and sixth month. Results: The groups were matched for pre fracture characteristics and post reduction evaluation. The mean follow up period in group A was 6.9 months and in group B was 7.1 months. Closed reduction failed in two patients at the rst attempt and one patient failed to retain reduction at rst week in group A. 11 patients (5 in group A and 6 in group B) were lost to follow up. Range of movement, valgus, varus and carrying angle of elbow in two groups were not signi cantly different. The mean difference of carrying angle of affected elbow as compare to normal elbow was signi cant in group A (p 0.05). Flynn’s overall rating showed 32% excellent, 36% good, 18% fair and14 % poor result in patents treated with long arm slab as compared to 58% excellent, 29% good, 13 % fair and no poor results in patients with crossed Kirschner wires xation. Conclusion: The outcome of displaced extension type supracondylar fracture of the humerus in children, managed with closed reduction and slab application are comparable with closed reduction and crossed Kirschner wire xation in terms of range of motion but is inferior in restoration of carrying angle. Good to excellent cosmetic and functional results are higher with crossed percutaneous Kirschner wires xation than with slab immobilization. Key words: closed reduction; percutaneous xation; supracondylar fracture