Journal Issue: Volume: 9, No 2, Issue 34, APRIL-JUNE, 2011
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Volume
Number
Issue Date
2011
Journal Title
Journal ISSN
1812-2027
Journal Volume
Articles
Ipsilateral Supracondylar Fracture and Forearm Bone Injury in Children: A Retrospective Review of Thirty one Cases
(Kathmandu University, 2011) Dhoju, D; Shrestha, D; Parajuli, N; Dhakal, G; Shrestha, R
ABSTRACT
Background
Supracondylar fracture and forearm bone fracture in isolation is common
musculoskeletal injury in pediatric age group But combined supracondylar fracture
with ipsilateral forearm bone fracture, also known as floating elbow is not common
injury. The incidence of this association varies between 3% and 13%. Since the
injury is rare and only limited literatures are available, choosing best management
options for floating elbow is challenging.
Method
In retrospective review of 759 consecutive supracondylar fracture managed in
between July 2005 to June 2011, children with combined supracondylar fracture
with forearm bone injuries were identified and their demographic profiles, mode
of injury, fracture types, treatment procedures, outcome and complications were
analyzed.
Result
Thirty one patients (mean age 8.91 yrs, range 2-14 yrs; male 26; left side 18) had
combined supracondylar fracture and ipsilateral forearm bone injury including
four open fractures. There were 20 (64.51%) Gartland type III (13 type IIIA and 7
type III B), seven (22.58 %) type II, three (9.67 %) type I and one (3.22 %) flexion
type supracondylar fracture. Nine patients had distal radius fracture, six had distal
third both bone fracture, three had distal ulna fracture, two had mid shaft both
bone injury and one with segmental ulna with distal radius fracture. There were
Monteggia fracture dislocation, proximal ulna fracture, olecranon process fracture,
undisplaced radial head fracture of one each and two undisplaced coronoid
process fracture. Type I supracondylar fracture with undisplaced forearm were
treated with closed reduction and long arm back slab or long arm cast. Displaced
forearm fracture required closed reduction and fixation with Kirschner wires or
intramedullary nailing. Nineteen patients with Gartland type III fracture underwent
operative intervention. Among them nine had closed reduction and K wire fixation
for both supracondylar fracture and forearm bone injury. One patient with closed
reduction and long arm cast application for both type III supracondylar fracture
and distal third radius fracture developed impending compartment syndrome
and required splitting of cast, remanipulation and Kirschner wire fixation. There
were three radial nerve, one ulnar nerve and one median nerve injury and two
postoperative ulnar nerve palsy. Three patients had pin tract related complications.
Among type III, 16 (80%) patients had good to excellent, two had fair and one gad
poor result in terms of Flynn’s criteria in three months follow up
Conclusion
Displaced supracondylar fracture with ipsilateral displaced forearm bone injuries
need early operative management in the form of closed reduction and percutaneous
pinning which provides not only stable fixation but also allows close observation for
early sign and symptom of development of any compartment syndrome.
KEYWORDS
Floating elbow; Forearm bone injury; Ipsilateral fracture; Supracondylar fracture
Variability of Presentations and CT-Scan Findings in Children with Neurocysticercosis
(Kathmandu University, 2011) Gauchan, E; Malla, T; Basnet, S; Rao, KS
ABSTRACT
Background
Neurocysticercosis is one of the common neurological morbidities in childhood.
Objectives
To find the commonest mode of presentation of this disorder in children. The study
also aims to find out the age at which it commonly occurs, commonest site affected
in the brain and the ethnic group and region most commonly affected in Western
Nepal.
Methods
Retrospective hospital based study carried out in the Department of Pediatrics,
Manipal Teaching Hospital, Pokhara from June 2004 to June 2009.
Results
Over the period of five years, 678 patients were admitted for seizures; out of which
109 patients were diagnosed as having neurocysticercosis (16%). Out of them, 66
(60.5%) were males and 43 (39.4%) were females. The age of presentation varied
from 18 months to 16 years, with mean age 9.77 years. The most common age of
presentation was between 6-10 years (n=47; 43.1%) and 11-15 years (n=47; 43.1%).
Maximum number of patients were from Kaski district (n=41; 37.6%) followed by
Syangja (n=34; 31.1%).The commonest presentation was with seizures (n=85; 77.9
%); generalised seizures was present in 45 patients (52%). Psychiatric manifestations
were present in 3 patients (2.7%). The lesions were found mostly in the parietal
region (n=65; 59.6 %). Most of the lesions were single (n=89; 81.6%). Out of 109
patients, 74 patients (67.8%) improved without any recurrence of symptoms on
two years follow-up.
Conclusion
Neurocysticercosis is a preventable zoonotic disease which results in significant
morbidity in children where sanitary measures are inadequate. Any child presenting
with a first episode, afebrile seizure should be screened for neurocysticercosis
provided other common causes are ruled out.
KEY WORDS
neurocysticercosis, seizures
The Glucose Challenge Test for Screening of Gestational Diabetes
(Kathmandu University, 2011) Shrestha, A; Chawla, CD
ABSTRACT
Background
The frequency of gestational diabetes mellitus (GDM) is 0.6% -15% of pregnant
woman. The modern trend towards the delay starting family is the main factor
responsible for increase prevalence of GDM. This condition is associated with
the adverse effect on mother and fetus, so it is important to find out the GDM by
screening of all the pregnant women.
Objective
To observe the feasibility of using the 50g GCT for all pregnant women attending
Dhulikhel Hospital, Obstetric OPD. To determine the incidence of gestational
diabetes in the population and to observe the maternal and fetal outcome among
those having an elevated GCT level and gestational diabetes.
Methods
A prospective and analytical study of 1598 pregnant women booked and delivered
between June 2009and August 2010. Glucose challenge test (GCT) performed by
using 50gm glucose and diagnosis of gestational diabetes performed by using the
Carpenter Coustan Criteria. Pregnancy outcomes were assessed by the gestation and
mode of delivery. Similarly, neonatal outcomes assessed in terms of birth weights,
APGAR scores, congenital abnormalities, hyperbilirubinaemia, hypoglycaemia or
respiratory distress syndrome.
Results
The detected incidence of gestational diabetes was 0.75%. With the threshold
plasma glucose level at140 mg/ dl, 198 women needed to undergo the 100g oral
glucose tolerance test and 12 women had gestational diabetes. The diagnostic yield
was 6.06%. Perinatal outcome was similar to the rest of the women with normal
glucose challenge test.
Conclusions
The 50g GCT is feasible and also helps to find out GDM. It is easy, user friendly,
cheap and convenient for screening purpose.
KEY WORDS
Glucose challenge test, gestational diabetes, oral glucose tolerance test
The Burden of Injury in terms of Economic Loss and Disability Days: A Community Based Study from Eastern Nepal
(Kathmandu University, 2011) Ghimire, A; Nagesh, S; Jha, N; Niraula, SR; Devkota, S
ABSTRACT
Background
Injuries are already a substantial public Health problem all over the world and are
expected to increase in the 211st Century. They are major causes of deaths and
disability in the population and also involve high societal costs.
Objectives
This study was designed to assess the economic loss due to the injury and the
disability days due to different types of injuries.
Methods
A systematic random sampling technique was used to select 1388 households
from 19 wards. A detailed questionnaire was used to collect information related to
injuries to the persons suffered from injuries including treatment obtained, cost of
treatment (direct/indirect cost) and length of disability.
Results
Among the minor injured persons, majority (93.2%) did not spend any indirect cost.
36.7% of the major inured persons spent Nepalese rupees 10,001 to NRs 100,000
as direct treatment costs. But 50% spent less than 5000 NRs as indirect cost for
major injury treatment. Maximum number (67.4%) of major injured persons had
disability days of 31 to 90 days.
Conclusion
The high incidence of injuries, especially road traffic injuries, adds a huge economic
burden to nation.
KEY WORDS
injury, disability days, economic burden