A comparative study of Infra patellar branch of saphenous nerve injury between vertical and horizontal portal incisions in knee arthroscopy.

Background: An Infrapatellar Branch of Saphenous Nerve (IPBSN) injury is one of the complications leading to sensory loss in the operated knee. A high incidence of IPBSN injury was reported during hamstring harvest, but there are only a few studies analyzing IPBSN injury during arthroscopy portals. However, there was a lack of randomized comparative studies comparing the incidence of IPBSN injury in horizontal and vertical portals. This study aimed to identify the overall incidence of IPBSN injury and compare the difference between vertical and horizontal portal incisions. We also aimed to observe the recovery pattern of IPBSN injuries in both groups. We hypothesize that since the portal incisions are very small, the incidence of IPBSN injury will be very low, and it will occur more in the vertical incision. Methods: After obtaining IRC approval from B&B Hospital IRC, this prospective comparative study was conducted at the AKB center for arthroscopy, sports injury, and regenerative medicine, B&B Hospital. The calculated sample size of 128 consecutive patients was included and divided into groups by the block randomization method. A total of 64 patients were allocated to both groups. Demographic data was recorded. The sensory loss along the IPBSN was examined and documented on the first postoperative day. Their recovery was documented during two weeks and three months of follow-up visits. Parametric and non-parametric tests were applied to analyze the variables. Results: IPBSN injury was seen in 12 patients (9.37 %) among 128 study participants. Five patients (7.81 %) had IPBSN injuries in the vertical group compared to seven (10.93 %) in the horizontal group. Recovery was earlier in the horizontal incision group. Conclusion: The overall incidence of IPBSN injury during the arthroscopy portal is low. They occur equally in vertical and horizontal portal incisions. The recovery of the IPBSN injury was better and earlier in the horizontal incision group.

Thoraco-lumbar Burst Fractures among Patients Admitted to Spine Unit of the Department of Orthopedics of a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Burst fractures are the most common fractures in the thoracolumbar junction. Unstable burst fractures are mostly associated with neural injury. Early neurological and mechanical stabilisation are the goals of treatment. The aim of this study was to find out the prevalence of thoracolumbar burst fractures among patients admitted to the spine unit of the Department of Orthopedics of a tertiary care centre. Methods: This descriptive cross-sectional study was done in a tertiary care centre from 1 January 2021 to 31 December 2021 after receiving ethical approval from the Institutional Review Committee (Reference number: 079/80-11/BHG). Demographic details, mode of injury, morphology, neurological level, and neurological grade using the American Association of Spinal injury, Visual analogue Scale, Oswestry Disability Index and kyphotic angle were recorded. A convenience sampling method was used. Point estimate and 90% Confidence Interval were calculated. Results: Among 85 patients, the thoracolumbar burst fractures was found in 30 (35.25%) (26.73-43.77, 90% Confidence Interval). The mean age of patients was 39.73±13.91 years. Conclusions: The prevalence of thoracolumbar burst fracture was similar to other studies done in similar settings. Keywords: fracture; injuries; prevalence; spine.

Variations in common operations in athletes and non-Athletes.

Background: Achieving pre-injury activity level after an injury is the fundamental goal of any orthopedic treatment for an athlete. Unfortunately, pre-injury activity levels differ significantly in different patient categories, especially in athletes and non-athlete. Hence, an outcome suitable to a non-athlete may not be adequate for an athlete. This has led to variations in the surgical approach to the same injury in an athlete and non-athlete.There is plenty of literature published comparing the outcome in athletes and non-athletes after a particular surgery. Scattered discussion about variations in these surgeries based on functional demand was done in many publications. But there was a lack of a comprehensive narrative review summarizing variations in common operations among athletes and non-athletes. Aim: This review attempted to summarize variations in common sports operations between high functional demand patients and low demand patients and discuss the variations from the author's perspective. Methods: A review of all the relevant papers were conducted focusing on athletes and non-athletes. Most commonly performed sports surgeries were ACL reconstruction, Meniscal repair, PCL reconstruction, and Shoulder instability surgery. A literature search was done for each commonly performed surgery using relevant keywords in PubMed and Google Scholars. Summary of papers pertinent to athletes and non-athletes were compiled to prepare this narrative review. Results: There is a lack of papers directly comparing results in athletes and non-athletes. However, many research papers discussed surgical variations in athletes (high demand) and non-athletes (low demand) patients. There are controversies in all commonly performed surgeries, and none of the papers gives a definitive guideline on the approach to athletes and non-athlete. Conclusion: Rather than a common suggestion on surgical variation, an individualized approach would be appropriate to decide on variation in particular surgery in both athletes and non-athletes.

Traumatic Spinal Injury among Patients with Spinal Injuries Admitted to the Spine Unit of a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Traumatic spinal injury is a major source of morbidity and mortality throughout the world. The number of spinal injuries is growing annually but epidemiological and demographic features may be different in different regions. This study aims to find out the prevalence of traumatic spinal injury among patients with spinal injuries admitted to the spine unit of a tertiary care centre. Methods: This was a descriptive cross-sectional study was done on a total of 102 traumatic spinal injury patients admitted to the spine unit of a tertiary care centre from 1st June, 2019 to 31st May, 2021 after receiving ethical approval from the Institutional Review Committee (Reference number: 077/78-09). Demographic details, mode of injury, morphology, patterns of fractures, neurological level, and management methods in the hospital were recorded. Convenience sampling was done. Data were analysed using the Statistical Package for the Social Science version 24.0. Point estimate at 95% Confidence Interval was calculated along with frequency and percentages for binary data. Results: Among 130 spinal injury patients, the prevalence of traumatic spinal injury was found to be 102 (78.46%) (71.39-85.53 at 95% Confidence Interval). The most common mode of spinal injury was due to falls in 80 (78.43%) cases. Conclusions: The prevalence of traumatic spinal injury was higher when compared to the other studies done in similar settings. Keywords: falls; polytrauma; spinal cord injuries; trauma.

Prevalence of Nerve Injuries in Supracondylar Fracture of Humerus in a Tertiary Care Hospital.

BACKGROUND: Supracondylar fracture is a common childhood injury. These fractures are often associated with neural and vascular injuries. There is discrepancy in literature about the most common nerve injured in such fractures. This study aims to study the nerve injury patterns in supracondylar fractures of humerus in Nepalese children. METHODS: This descriptive cross sectional study was conducted in 152 children (aged 2 to 14 years) with supracondylar fractures of humerus attending in Bharatpur Hospital during the period of one year. All eligible patients were assessed clinically and radiologically. Neurological assessment was done for nerve injury. RESULTS: Out of 152 children, 18(11.8%) had nerve injuries. The mean age was 7.41±2.91 years. Boys were more injured (68.4%) than girls (31.6%). It was more common on non-dominant side (57.9%). Out of 18 nerve injuries, most commonly injured nerve was median nerve 10(55.5%) followed by radial nerve 7(38.9%). Median nerve injury was common in posterolateral displacement and radial nerve injury was common in posteromedial displacement type of fracture.   Conclusions: Displaced supracondylar fractures have relatively higher prevalence of nerve injuries. Most commonly involved nerve is median nerve followed by radial nerve. So, every displaced fracture should be routinely screened for nerve injuries.

Osteoporosis among Postmenopausal Women Attending the Orthopedics Department of a Tertiary Care Hospital: A Descriptive Cross-sectional Study.

INTRODUCTION: Osteoporosis and resulting fracture is a major public health concern worldwide. With increase in life expectancy, osteoporosis and fragility fracture is expected to be more prevalent. It is associated with high patient morbidity, while hip and vertebral fractures have high mortality. The real burden of the problem is yet to be established in developing countries like Nepal. This study aims to find out the prevalence of osteoporosis among postmenopausal women visiting a tertiary care hospital. METHODS: This descriptive cross-sectional study was conducted among 89 postmenopausal women attending at Orthopedic Outpatient Department of Bharatpur Hospital from 1st January 2019 to 30th December 2019 with postmenopausal status. The ethical clearance was taken from the Institutional Review Committee of Bharatpur Hospital. Convenience sampling technique was used. Bone Mineral Density was estimated with dual energy x-ray absorptiometry scan Statistical Package for Social Science was used for analysis. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. RESULTS: Out of 89 postmenopausal women, 29 (32.58%) (Confidence Interval = 32.48-32.68) women had osteoporosis. The mean age and Bone Mineral Density were 62.16±8.17 years and 0.968±0.14 g/cm² respectively. The women with history of fragility fracture had low bone mineral density. CONCLUSIONS: Prevalence of osteoporosis was high. Women with history of fragility fracture are at increased risk of another fragility fracture. It is hence necessary to have awareness programs and early screening to minimize the magnitude of morbidity and mortality associated with osteoporosis.

Hoffa Osteochondroma - Para-articular Extrasynovial Infrapatellar Fat Pad Osteochondroma: A Case Report.

Osteochondroma usually arises from the metaphyseal region of growing bones. The occurrence of extraskeletal osteochondroma is rare with very few case reports. Para-articular osteochondroma is a type of extraskeletal osteochondroma. It frequently occurs around the knee, usually at infrapatellar Hoffa's fat pad. It is usually intracapsular but extrasynovial and arises from the capsule and connective tissues due to osteocartilaginous metaplasia. We present a case of 19-years male with anterior knee pain for 3 years, swelling, and deformity of the knee with flexion limitation for one year. Radiography revealed ovoid, corticated lesion free from adjoining bones. Mass interpreted as benign, so planned for excision. Well circumscribed nodule excised from the medial parapatellar approach. Histology revealed cartilaginous tissues surrounded by fibrous tissues with scattered enchondral ossification. Postoperatively and subsequent follow-up resulted in pain-free joint, complete recovery of range of motion with no clinicoradiological evidence of recurrence.

Demography of Total Joint Replacement Surgeries Performed in a Tertiary Care Hospital: A Cross-sectional Survey.

INTRODUCTION: Total joint replacement of hip and knee is considered as one of the most successful orthopedic surgeries in the twenty-first century because of the only solution to end-stage arthritis of these joints. The real burden of the problem is yet to be established in developing countries like Nepal. This study aims to describe the demographic findings of the joint replacement surgeries among total lower limb surgeries in a tertiary care hospital. METHODS: This cross-sectional survey was conducted using the hospital records of 73 total joint replacement surgeries of the lower limb in the Department of Orthopedics of a tertiary care hospital from November 2016 to November 2020. Ethical approval was taken from the Institutional Review Committee (reference number: 077/78-011). Convenience sampling was done. Data analysis was done using the Statistical Package for the Social Sciences version 20. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage for binary data. RESULTS: There were 73 total joint replacement of hips and knees. Of which, 32 (43.84%) total hip replacements were done in which one (3.13%) patient had a simultaneous bilateral hip replacement in single-stage and the other one (3.13%) had two-stage bilateral hip replacement. Forty one (56.16%) total knee replacements were done in which 18 (24.65%) had a simultaneous bilateral knee replacement and five (6.85%) had a unilateral knee replacement. CONCLUSIONS: Total joint replacements of the hip were more common among the lower limb surgeries.