Lumbar Disc Degenerative Disorder among Patients Undergoing Magnetic Resonance Imaging in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Magnetic resonance imaging is the standard imaging modality for detecting disc pathology due to its advantage of lack of radiation, multiplanar imaging capability, excellent spinal soft-tissue contrast, and precise localization of intervertebral discs changes. The aim of the study is to find out the prevalence of lumbar disc degenerative disorder among patients undergoing magnetic resonance imaging in a tertiary care hospital. Methods: A descriptive cross-sectional study was conducted in the Department of Radiodiagnosis and Interventional Radiology of a tertiary care centre among patients with complaints of low back pain from 24th May, 2021 to 31st December, 2021 in a tertiary care hospital. Ethical clearance was taken from the Institutional Review Committee (Reference number: 134/2077-78). A sample size of 899 was taken and convenience sampling was done. Collected data were entered and analyzed on Statistical Package for the Social Sciences version 22.0. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage for binary data and mean with standard deviation for continuous data. Results: Among 899 patients undergoing magnetic resonance imaging, the prevalence of lumbar disc degenerative disorder was found to be 155 (17.24%) (14.77-19.70 at 95% Confidence Interval). Conclusions: The prevalence of lumbar disc degenerative disorder among patients undergoing magnetic resonance in our study was lower when compared to other similar studies conducted in similar settings. Keywords: disc degeneration; low back pain; magnetic resonance imaging.

Outcome of Proximal Femoral Nail Antirotation II fixation of Peritrochanteric Fracture of Femur.

BACKGROUND: Intramedullary fixation is biomechanically superior to extramedullary fixation for fracture of peritrochanteric region of femur in elderly which is often complicated due to associated osteoporosis. Helical blade of proximal femoral nail antirotation II has stronger purchase in the head of femur preventing rotation and cutout. This study was done to evaluate the outcome of Proximal Femoral Nail Antirotation II fixation in B.P. Koirala Institute of Health Sciences. METHODS: Retrospective review of the data of 100 traumatic peritrochanteric fracture cases operated between March 2017 and March 2018 was done for study. Cases lost to follow-up, deaths and incomplete functional outcome (VAS, HHS), intraoperative and postoperative data were excluded. Total of 71 cases were included in the study. RESULTS: Mean age of patients was 65 (+14) (range:19 to 86) years and were operated for intertrochanteric (54), subtrochanteric (16) and neck of femur (1) fractures. Trivial fall on ground was the commonest mechanism of injury (43 of 71). Mean injury to surgery time was 7 (+7) days and mean duration of hospital stay was 5.92 (+4) days. Mean blood loss during surgery was 132.61 (+21) ml and mean surgical time was 56 (+8) minutes. Mean visual analogue scale (VAS) Score was 7 at 2 weeks, 3 at 6 weeks and 1 at 12 weeks. Mean harris hip score was 80 (+10) at 6 months. CONCLUSIONS: Proximal femoral nail antirotation II is a reliable implant system to use for fixation of proximal femoral fractures with a good functional outcome and low complication rates.

The role of Propionibacterium acnes in and Modic type 1 changes†:†A literature review.

Propionibacterium acnes (P. acnes) is part of the normal flora of human skin, oral cavity, intestinal tract and external ear canal. However, breach in the mucosa as well as ruptured annulus fibrosus provide favorable pathway for P. acnes to nucleus pulposus where it can proliferate under anaerobic condition. In past two decades many authors have identified P. acnes in routine culture of discs. There studies showed that almost 50% of discs cultured were positive for various organism, and in vast majority of culture positive disc, P. acnes was the primary organism isolated. However, there are few studies that refute the hypothesis that P. acnes has a role in pathogenesis of Modic type 1 changes. Identification of P. acnes in culture indicates the infective patho-mechanism in the pathogenesis of Modic type 1 changes, which may be ameable to antibiotic treatment. However, it is still difficult to identify which subset of these patients (patients with low back pain with type 1 Modic change) are infective in nature. Further investigation and more clinical trails will be required for clear identification of the infective subgroup among low back patient in general. J. Med. Invest. 67 : 21-26, February, 2020.

Pigmented villonodular synovitis of the knee joint in a 5-year-old girl treated with combined open and arthroscopic surgery: a case report.

Pigmented villonodular synovitis is an extremely rare disease in skeletally immature patients. Erosive destruction of the involved joint leads to early arthritis, and its high recurrence rate makes treatment challenging. Multiple surgical approaches exist, but it is unclear as to which among them achieves the lowest possible recurrence rate and morbidity. We report the case of a 5-year-old girl with left knee pain and swelling who was diagnosed with diffuse pigmented villonodular synovitis of the left knee based on MRI findings. Combined open and arthroscopic surgery was performed to completely remove the tumor. Postoperative histopathological examination confirmed the diagnosis of diffuse pigmented villonodular synovitis. The postoperative course was uneventful, with a gradual improvement in symptoms. There were no signs of recurrence on postoperative MRI performed at the 8-month follow-up, with neither knee pain nor limitation of range of motion. The favorable outcome in this case suggests that combined open and arthroscopic surgery may be an effective method for treating pigmented villonodular synovitis in skeletally immature patients.