Browsing by Author "Thapa, SS"

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    Accuracy of Lelli Test For Anterior Cruciate Ligament Tear
    (Institute of Medicine, 2015) Thapa, SS; Lamichhane, AP; Mahara, DP
    Abstract Introduction: The anterior cruciate ligament (ACL) is an important stabilizer of the knee. Rupture of the ACL, unfortunately, is a common sports injury. Three most accurate test routinely applied in clinical practice to determine ACL injuries are the Anterior drawer, Lachman, and pivot shift tests test .In this study we evaluate the accuracy of Lelli test for detecting ACL tear and compare it with those tests. Methods: This study included 80 patients attending sports clinic at Department of orthopedics, Tribhuvan University, Teaching Hospital from December 2013 to November 2014, aged between 20-45 years with knee symptoms of giving way/locking/pain following sports or non sports injury .Clinical history and detail clinical assessment of knee for instability including Anterior drawer test, Lachman test, Pivot shift test ,Lelli test were performed by standard technique and recorded in the Performa. All patient underwent knee arthroscopic evaluation and needful procedure by an experienced arthroscopic surgeon. Arthroscopy findings of ACL tear was recorded and used to assess the reliability of clinical test. Results: In this study sensitivity of Anterior drawer test, Lachman test , Pivot shift test , Lelli test was 80.00%(CI 62.53-90.93),91.42%(CI 75.81-97.75) ,51.42%(CI 34.27-68.27), 85.71%(CI 68.95-94.61) respectively and Specificity was 93.33%(CI 80.68-98.28), 95.55%(CI 83.36-99.22), 100%(CI 90.20- 100.00) , 91.11%(CI 77.87-97.11) respectively. Conclusion: Lelli test being simple test can be routinely used in evaluation of ACL function in both acute and chronic knee injury. Keywords: Anterior drawer test, Lachman test, Pivot shift test, Lelli test
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    Functional outcome of single bundle anatomical anterior cruciate ligament reconstruction using either quadruple hamstring or bone patellar tendon bone graft by medial portal technique
    (Institute of Medicine, 2018) Thapa, SS; Neupane, P; Lamichhane, AP; Mahara, DP
    Abstract Introduction: The anterior cruciate ligament (ACL) is the most frequently injured knee ligament. Abnormal knee kinematics in ACL deficient knee causes early osteoarthritis. Single bundle anatomical ACL reconstruction by medial portal technique provides better knee stability then transtibial technique. Many studies suggests that there is no difference in outcome of ACL reconstruction using hamstring or bone patellar tendon autograft. In this study we evaluated functional outcome(based on mean Lysholm score) at 6 month of single bundle ACL reconstruction by medial portal technique using bone patellar tendon bone or quadruple hamstring graft Methods: This was a prospective longitudinal study on functional outcome(using Lysholm score) of 75 patients who underwent single bundle anatomical ACL reconstruction by medial portal technique by using either quadruple graft hamstring or bone patellar tendon bone graft in sports and arthroplasty unit in Tribhuvan University teaching hospital, Kathmandu, Nepal between March 2014 to February 2016. Mean Pre op and 6 month postop Lysholm score of two groups was compared using paired-t test to evaluate the functional outcome of the surgery. Results: In this study overall mean preop Lysholm score was 48.48±6.50 (36-62) and 6 month postop Lysholm knee score was91.58±3.10 (85-95), with p value 0.0000. The mean preop and post op Lysholm score for Quadruple hamstring group was 47.7 and 91.5 respectively, while that for bone patellar tendon bone group was 54 and 91.7. Conclusion: The functional outcome (based on mean Lysholm score) at 6 month postop of single bundle anatomical ACL reconstruction was similar irrespective of type of graft used. Keywords: Anterior Cruciate Ligament (ACL), Lysholmscore, Medial Portal technique
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    Injury Epidemiology after 7.8 Richter Gorkha Earthquake in Nepal: A Retrospective Study of Injuries Treated at Tribhuvan University Teaching Hospital
    (Institute of Medicine, 2018) Thapa, SS; Lamichhane, A; Mahara, DP
    Abstract Introduction: Earthquakes are one of the most catastrophic natural disasters that occur without prewarning, Nepal experienced a massive earthquake of 7.8 Richter scale on 25th April 2015.It claimed 8,962 lives across several districts in Nepal with 22,302 injuries. After the earthquake, hospitals are confronted with large number of disaster trauma victims making it challenging for management of such mass casualty. Despite such crisis Tribhuvan University Teaching Hospital (TUTH) provided all possible services round the clock to all disaster victims brought to hospital from very first hour after the earthquake. Methods: This is a retrospective analysis of management of the injured patients admitted in TUTH after the Gorkha earthquake. Patient’s details including demographic data, injuries sustained and treatment carried out was retrieved from medical record section of the hospital. Injury pattern were categorized broadly into orthopedics related and non-orthopedics injure. Frequency distribution of these data’s was calculated using Microsoft excel. Results: Out of 1812 earthquake related injuries treated in hospital, 493 injured cases required admission. Their mean age was 35.84±21.84 years. Of them 153(31.6%) cases were from Kathmandu and 133 (27.0%) from Sindhupalchowk and Ramechhap.364 cases had single injury and 129 cases had multiple injuries, 81% of the injuries were orthopedic related and 19 % were non-orthopedic injury. Out of them 361(73.2%) cases required surgery, 119 (24.1%) were managed conservatively, 13(2.6%) died. Conclusion: Earthquake is the most unpredictable catastrophic natural disaster. Limb fractures and soft tissue injuries are most common among the injury survivors. Knowing the nature and epidemiology of the injuries will help in effective management of available resources for benefit of maximum number of victims. Keywords: Earthquake, Orthopedics, Tribhuvan University Teaching Hospital (TUTH)
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    Neglected Medial Hoffa Fracture for 9 years -A Case Report
    (Institute of Medicine, 2016) Thapa, SS; Lamichhane, A; Mahara, DP
    Abstract Hoffa fractures, coronal fractures of the femoral condyle, are uncommon injuries. It is often missed on initial plain radiographs. Medial Hoffa fractures are three times less common then lateral Hoffa. Here we present a case of neglected non-union of medial Hoffa fractures for 9 years, with good outcome after Open reduction and internal fixation. Keywords: Hoffa fracture, Non-union
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    Pretibial Cyst after Anterior Cruciate Ligament Reconstruction with Non-bioabsorbable Interference Screw
    (Institute of Medicine, 2018) Thapa, SS; Lamichhane, A; Mahara, DP
    Abstract Pretibial cyst formation after anterior cruciate ligament reconstruction is a rare late complication. Exact etiology is not known, but it is commonly reported with use of bioabsorbable screw for fixation. Here we report a very rare case of pretibial cyst after anterior cruciate ligament reconstruction even with use of non-bioabsorbable screw for fixation. Keywords: Anterior cruciate ligament (ACL), Pretibial cyst, Titanium screw
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    The Prognostic Value of the Fracture Level in the Treatment of Displaced Supracondylar Humeral Fractures in Children
    (Kathmandu University, 2020) Gaihre, SK; Uprety, S; Thapa, SS
    ABSTRACT Background Supracondylar fractures are subclassified as high and low type depending on whether they are above or below the isthmus of the distal humerus and it play an important role in determining outcome. Objective To compare the clinical and radiological outcomes of patients with fractures above and below the distal humeral isthmus treated with closed reduction and percutaneous pinning. Method This is a prospective non-randomized analytical study of 40 patients with displaced extension type supracondylar fracture of distal humerus treated by closed reduction and percutaneous pinning. Radiological and functional outcomes was followed up to 6 months postoperatively. The significance of differences between means (baumann angle, carrying angle and time to recovery) were calculated using the independent t-test. Result Twenty-four (60%) patients were high type and 16 (40%) patients were low type. According to Flynn grading, there was no statistical significance between the high type and low type (p = 0.601). The time to recovery for the high type was 15.58 ± 2.95 weeks and for low type was 18.75 ± 2.18 weeks. Hence, the time to recovery for the low type was longer than high type and it was statistically significant (p = 0.001). Conclusion Low type supracondylar fractures require a longer period for the gain of elbow range of motion. However, in long term the prognosis of low type is comparable with that of high type fracture. Hence, the prognostic value of fracture level in the treatment of displaced supracondylar fractures is not statistically significant. KEY WORDS Flynn’s grading, Fracture level, Supracondylar humeral fracture
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    Topiramate induced bilateral angle-closure glaucoma
    (Kathmandu University, 2007) Singh, SK; Thapa, SS; Badhu, BP
    Topiramate is a sulfamate-substituted monosaccharide and is used as an antiepileptic medication 1. It can also be used as a prophylactic agent for headache from migraine2 . The main purpose of this article is to create awareness among medical colleagues regarding severe ophthalmic side effect of topiramate. This is the first reported case of topiramate induced bilateral angle-closure glaucoma in Nepal. This case was managed successfully by discontinuing topiramate and by starting anti-glaucoma medication along with atropine eye drops which were tapered and eventually discontinued.

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