Browsing by Author "Thapa, J"
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Publication Assessing Spectrum of Fractures in Elderly; Perspective on Tertiary Care Hospital of Nepal(Kathmandu University, 2023) Parajuli, B; Sharma, R; Kayastha, SR; Thapa, J; Shrestha, R; Shrestha, DABSTRACT Background There is an increasing life expectancy and a surging elderly population in the last few decades, leading to a higher incidence of fractures in the elderly. The health care of the elderly in Nepal is below par and there are no studies done to evaluate the spectrum of fractures in the elderly. Objective To evaluate the demographical and epidemiological aspects of fractures in the elderly (≥ 65 years) presenting to a tertiary care hospital in Nepal in a 15 years’ timeline. Method This study was a retrospective epidemiological study conducted in the Department of Orthopedics, Dhulikhel Hospital, Kathmandu University Hospital (DH, KUH), Nepal. The patients of age ≥ 65 years having traumatic injuries, admitted in the orthopedics ward from 2006 January to 2020 December were included. Patient demographics, site of injury, fracture incidence, mechanism of injury, hospital stay duration, and mode of treatment (surgical/ conservative) were evaluated. Result Of the 787 patients with an average age of 73.65 ± 7.5 years, 54% were females. Peritrochanteric fracture was the most common fracture (29.4%) followed by spine (18.3%). The most common mechanism of injury was fall on the labeled ground (38.6%). The incidence of fragility fractures (peri-trochanteric, proximal humerus, spine, and distal radius) was increasing with age. Conclusion Females, peritrochantric fractures, and trivial trauma are the most common occurrences for fractures in elderly. The incidence of fragility fractures is increasing with age but the overall incidence of fractures compared to other studies is low. Higher incidences of road traffic accidents (RTA) and compound fractures among the elderly are serious public health concerns that highlight the importance of primary preventive measures. KEY WORDS Elderly, Fracture, Incidence, NepalPublication Coxsackie B Virus Infection as a Rare Cause of Acute Renal Failure and Hepatitis(Kathmandu University, 2018) Thapa, J; Koirala, P; Gupta, TNABSTRACT We report a 37 year female patient, admitted with complains of fever, jaundice and myalgia of seven days. There was no history of trauma, drug abuse, seizure or vigorous exercise nor history of renal and musculoskeletal disease. Here we have discussed the clinical features, biochemical derangements, diagnosis of coxsackie B virus, multi organ involvement and need of urgent hemodialysis for appropriate management of the case. KEY WORDS Acute renal failure, Coxsackie B, Hemodialysis, HepatitisPublication Hysterectomy: an analysis of perioperative and post operative complication(Kathmandu University, 2003) Saha, R; Sharma, M; Padhye, S; Karki, U; Pandey, S; Thapa, JObjective : To document peri operative and post operative complication observed after hysterectomy, regardless of route on the operator. Material and methods: A hospital based prospective study was carried out in department of obstetrics and gynaecology, KMCTH Sinamangal for six months. The study was carried out in patients undergoing hysterectomy who were followed from the time of admission to the time of discharge and two weeks thereafter. And followings were noted-Indication; route of hysterectomy, intraoperative and postoperative morbidities during hospital stay and after two weeks of discharge was noted. Result: Total number of hysterectomy carried out was 50. 31(62%) were Total abdominal hysterectomy, and 19(38%) were vaginal hysterectomy. Indication for total abdominal hysterectomy were fibroid uterus 12(24%), DUB 8 (16%), CIN 4(8%), chronic cervicitis 1 (2%). II U-V prolapse with previous LSCS 1 (2%), endometriosis 1(2%). Prophylactic for Ca breast 1(2%), Postmenopausal bleeding 1(2%). All cases of vaginal hysterectomy were performed for 2nd degree U-V prolapse. Intra operative complication during surgery were two cases of haemorrhage (4%) each in both total abdominal hysterectomy and vaginal hysterectomy. There was one case of bladder injury during abdominal hysterectomy. Postoperative complication noted were febrile morbidity 1(2%) in abdominal hysterectomy. Urinary tract infection remains the single most common febrile morbidity. There was one case of secondary haemorrhage in both type of hysterectomy. One was managed conservatively and other required laprotomy. There were three(6%) cases of wound infection in abdominal hysterectomy of two which were sanguineous discharge and one was frank pus which required secondary suture.Publication Neurological Outcome of Early versus Late Surgery Following Cervical Spinal Cord Injury(Kathmandu University, 2022) Kafle, P; Chaudhary, PK; Thapa, J; Sharma, MRABSTRACT Background There are numerous retrospective studies and a few prospective studies to determine the neurologic outcome after early versus late surgical treatment for cervical spinal cord injury. Objective To compare the neurological outcome between early (within 72 hours after injury) and delayed (≥ 72 hours after injury) surgery in patients with cervical spinal injury. Method This is a retrospective analysis of the neurological outcome of early versus late surgery following cervical spinal cord trauma. Patients meeting appropriate inclusion criteria were divided into an early or a late surgical treatment group. The neurologic outcomes and other complications were recorded up to six months of follow-up. Result Overall, there was a significant difference in neurological status at presentation and at follow-up (p < 0.001). However, there was no statistically significant difference between the early versus late surgery groups (p-value 0.261) in terms of neurological outcome. Complications were found to be higher among those undergoing posterior surgical approach (OR = 23.75; 95% CI 2.65, 212.98) than those with anterior or combined approach (p=0.005). However, multivariate analysis of these variables failed to show any statistically significant difference between the two groups. Conclusion The timing of surgery does not alter the neurological outcomes and the development of complications significantly. The American Spinal Cord Injury Association (ASIA) status at the time of presentation is found to be the single most important factor correlating with the neurological outcome. KEY WORDS American spinal cord injury association, Cervical spine, Spinal decompression, Spinal injury, Road traffic accidentPublication Osteosynthesis of Neck of Femur Fracture below 65 years of Age: does timing of surgery influence osteonecrosis, non- union and functional outcome?(Kathmandu University, 2021) Thapa, J; Shrestha, D; Kayastha, SR; Dhoju, D; Shrestha, R; Sharma, R; Regmi, RABSTRACT Background Influence of timing of injury surgery interval in outcome of osteosynthesis of neck of femur has always been a matter of debate. Patients in our set up have been surgically treated for neck of femur fracture with wide range of injury surgery interval which could have resulted in varied functional outcome and radiological outcome. Objective To evaluate the difference in functional outcome, femoral head osteonecrosis and non-union in fracture neck of femur fixed within and after twenty-four hours. Method All patients, who had undergone osteosynthesis for the neck of femur fractures via open or closed technique from 2010 to 2018 were analyzed retrospectively. The cases were examined and evaluated in terms of injury surgery interval, fracture union, functional status using Modified Harris Hip Score, complications like femoral head osteonecrosis and non-union. Result Fifty patients with an average injury surgery interval of 34±28 hours were evaluated. Twenty three (46%) cases were included in early surgery group (< 24 hours) and 27 (54%) patients were included in delayed (> 24 hours) surgery group. Incidence of femoral head osteonecrosis was reported in two (4%) cases, both being in delayed fixation group (p=0.49). Non-union was reported in four (8%) patients, one in early fixation group and three in delayed fixation group (p=0.61). The average Modified Harris Hip Score in early fixation group was 87 and in delayed fixation group was 84 (p=0.1). Forty two (84%) cases had a good quality of reduction and eight (16%) had a poor reduction. Non-union and functional outcome significantly differed between the good and poor reduction group (p=0.001 and 0.004 respectively). Conclusion There is no significant difference in the functional and radiological outcome of cases operated before and after 24 hours for osteosynthesis of neck of femur fractures in patients 16 to 65 years age group. However, poor reduction is significantly associated with the increased rate of non-union and poor functional outcome. KEY WORDS Femur neck, Non-union, Osteonecrosis, OsteosynthesisPublication Outcome of Achilles Tendon Repair using Four Strand Cross Locked Cruciate Repair Technique(Kathmandu University, 2021) Dhoju, D; Thapa, JABSTRACT Background Four strand cross locked cruciate tendon repair technique for Achilles tendon rupture has shown promising result. Objective To evaluate the outcome of all acute traumatic Achilles tendon rupture case treated by a novel repair technique of four strand cross locked cruciate. Method A total of 40 cases of acute traumatic Achilles tendon rupture from 2011 to 2018 treated by four strand cross locked cruciate repair technique were retrospectively evaluated using Achilles Tendon Total Rupture Score. Result Average age of patient was 29.45 years. Male preponderance was seen. Most of the patient (97.5%) had complete rupture of Achilles tendon. Most of the patient (92.5%) had open injury. The average length of hospitalization was 7 days. All the patients recovered to the level of physical activity previous to the tendon lesion. The achilles tendon total rupture score significantly improved from 6 month post op period to 12 months (p=0.02) and 2 years post op period (p=0.038). Conclusion The optimum method of suturing technique for acute traumatic rupture of Achilles tendon remains controversial. The four strand cross locked cruciate repair technique provides a stable and reliable construct for the Achilles tendon repair. The technique requires further investigation with direct comparison with other mostly used techniques like Krackow and Gift box suture technique. KEY WORDS Achilles tendon, Locked cruciate, Repair technique