Browsing by Author "Singh, MP"
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Publication Controversies in Orthopaedic Trauma- Management of Fractures of Shaft of Femur in Children Between 6 and 12 Years of Age(Kathmandu University, 2014) Jain, A; Agarwal, A; Gulati, D; Singh, MPABSTRACT The management of femoral shaft fractures in children is largely directed by the age and built of the child. There is wide consensus on the non operative treatment of children less than six years of age. Operative treatment is recommended for children more than 12 years of age, only the surgical options vary. The age group of 6-12 years remains a controversial area with multiple studies advocating different lines of treatment. We studied the literature on treatment of femoral shaft fractures in 6 to 12 year age group over the past 25 years through PubMed search and found 79 studies dealing with management of paediatric shaft femur fractures in this age group. Studies dealing with other age groups, animal studies and languages other than English were excluded. The treatment modalities included early or immediate hip spica, traction alone, external fixator, plating (open/minimally invasive), intramedullary nailing- rigid/flexible and intramedullary Kirschner wire. The short listed articles were studied for rate and time of union, complications such as non-union and malunion, leg length discrepancy, infection, implant impingement, refracture and cost analysis. Operative treatment is usually the preferred treatment option in this age group, as it decreases hospitalization time, decreases morbidity and allows early return of child to school. Flexible intramedullary nailing is recommended for length stable fractures. Submuscular bridge plating (minimally invasive) is reserved for comminuted fractures. External fixator is reserved for open fractures and initial stabilization of femoral shaft fractures in polytrauma pediatric patients. Intramedullary K wire is a viable option in resource contrained centres where specialized implants and instrumentation is not available. KEYWORDS Children, femur, fracture, paediatric, shaftPublication 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 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 fracturePublication Viral infections in sudden hearing loss. Do we have enough evidence?(Kathmandu University, 2005) Mishra, B; Panda, N; Singh, MP; Ratho, RKObjective: The aetiology of sudden deafness remains unknown even though some evidences suggest that it could be viral in origin. This study aimed to find out the relationship between viral infections and sudden sensorineural hearing loss. Methods: 32 patients presenting with sudden deafness and 10 healthy controls were included in the study. IgM antibodies to varicella zoster virus, measles, cytomegalovirus and herpes simplex virus were detected using micro ELISA. Results: Overall, 7(21.8%) patients showed seropositivity to one or more viruses. Virus specific IgM antibodies against measles and varicella zoster could be demonstrated in 4 (12.5%) and 3 (9.4%) patients respectively. None of the samples were found to be positive for herpes simplex virus (HSV) and human cytomegalovirus (HCMV) specific IgM antibodies. Controls were negative for all the viruses tested. The difference in seropositivity between the patient and control group was not statistically significant (p>0.05). Conclusion: Thus, this study suggests that sudden deafness is not commonly associated with a systemic viral infection. Key Words: Sudden deafness, viruses, serology.