Morphometric Study of Sub Axial Cervical Spine Pedicles in Nepalese Population.

BACKGROUND: Mal-positioning of cervical screws risks neurovascular injury so, it is necessary to understand cervical pedicle morphology for pedicle screw fixation in the region. The risks of pedicle screw insertion in the cervical spine can be mitigated by a three-dimensional appreciation of pedicle anatomy. The study aims to determine the morphology of the sub axial cervical spine pedicles in Nepalese Population based on computerized tomography. METHODS: A cross-sectional study using computerized tomography scans of the spine was made among the randomly selected 87 patients who had visited National Trauma center, Kathmandu, Nepal with vertebral fracture other than cervical vertebrae. Patient was examined as per Advanced Trauma Life support protocol and neurological assessment. Measurement was done from the third cervical vertebra down to the seventh cervical vertebra in computer with standard software in the department of radiology from where all the computerized tomography scan reporting are done. RESULTS: The mean pedicle length ranged from 4.41 mm at C3 to 4.96 mm at C7 where mean pedicle height ranged from 4.64 at C3 to 5.12 at C7. Pedicle length, pedicle height and pedicle width were observed to be statistically significant with gender. The pedicle axial length of C3 and C7 vertebra were found significant with gender. All parameters were found to be greater in male compared to female. CONCLUSIONS: The study revealed that pedicle length, pedicle height, pedicle width, pedicle axial length increased from third to seventh cervical however, transverse angulation increased up to fifth vertebra and decreased to seventh vertebra.

Incidental Finding of a Thorn in the Left Knee Joint of an Amateur Football Player and Arthroscopic Removal: A Case Report.

CASE: A 19-year-old male amateur footballer was referred to our center with complaints of relapsing and remitting pain, swelling, and reduced range of motion of the left knee. History, radiological, and laboratory findings were unrevealing, except for chronic synovitis. On arthroscopy, a 3.3 × 0.3-cm thorn was found embedded in the anteromedial aspect of the anterior cruciate ligament and was carefully removed. The postoperative course was uneventful. CONCLUSION: The foreign body must be considered as differential diagnoses in players presenting with unilateral chronic synovitis of the knee. Knee arthroscopy is the gold standard for both diagnostic and therapeutic purposes when the history is unclear, and radiological investigations are inconclusive.

Outcomes of single bundle arthroscopic anterior cruciate ligament reconstruction in a limited resource setting.

OBJECTIVES: Despite various challenges, orthopaedic sports surgeons are still providing the arthroscopic service in low-income and middle-income countries like Nepal; however, it is hardly being reported. The main purpose of this study was to compare the clinical outcomes and complications of patients undergoing arthroscopic anterior cruciate ligament reconstruction (ACLR) in the urban group and that of the rural group. METHODS: We evaluated a total of 194 patients, including 98 patients in the urban group and 96 patients in the rural group, undergoing arthroscopic ACLR between August 2015 and February 2018, and had completed a minimum of 2-year follow-up. Subjective evaluations were performed using the Tegner-Lysolm score and International Knee Documentation Committee (IKDC) subjective knee evaluation form. Laxity assessments were performed using the Lachman test and the Pivot-shift test. Functional evaluation included the range of motion, single-leg hop test and overall IKDC score. Radiological assessment was performed according to the IKDC guidelines. SPSS was used for data analysis. RESULTS: There was statistically significant differences in the subjective assessments between 2 groups. No statistically significant differences existed between 2 groups in terms of laxity and functional assessments. However, the proportion of laxity, in terms of Lachman test and Pivot-shift test, was higher in the young and active individuals and the proportion of abnormal and severely abnormal in all parameters of functional outcomes was higher in the older female in the rural group. Graft failure occurred in 19 (17.6%) knees in the urban group and 17 (16.8%) knees in the rural group. Graft failure in the urban group was higher in young and active male patients, whereas failure in the rural group was more in female patients. Similarly, overall infection occurred in 13 (6.2%) knees, including 5 (2.3%) deep infections and 8 (3.8%) superficial infections. CONCLUSION: We advised similar rehabilitation protocol for all the patients; however, the outcomes were significantly lower in patients living in rural areas as they are found to have poor compliance with the rehabilitation protocol. The overall graft failure rate was 17.2%; however, the reoperation rate was higher in the urban group than the rural group. The rate of deep infection was higher in the rural group as compared with the urban group. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Comparative study of arthroscopic Bankart repair versus open Latarjet procedure for recurrent shoulder dislocation.

OBJECTIVES: The primary aim of this study was to compare the clinical outcomes of patients undergoing arthroscopic Bankart repair and the open Latarjet procedure for recurrent dislocation of the shoulder. The secondary aims were to assess and compare the surgical cost, patient satisfaction, and complications, including recurrence and infection. METHODS: We retrospectively compared the clinical outcomes of all consecutive patients undergoing either arthroscopic Bankart repair or the open Latarjet procedure from May 2015 to May 2018 with a minimum 2-year follow-up. Forty-one patients (32 men, 9 women) in the Bankart group and 40 patients (34 men, 6 women) in the Latarjet group were available for the final follow-up. RESULTS: There were no statistically significant differences in the demographic parameters or clinical outcomes between the two groups. Functional satisfaction was higher with the Latarjet procedure. Bankart repair had a significantly higher operating cost than the Latarjet procedure. Three patients in the Bankart group and no patients in the Latarjet group developed recurrence. CONCLUSION: Both procedures provided satisfactory clinical outcomes. However, the Latarjet group had a higher rate of functional satisfaction and lower operating cost, and there was a trend toward higher recurrence in the arthroscopic Bankart group.

Management of Neglected Post-traumatic Bilateral Facet Dislocation of Sub-axial Cervical Spine: A Case Series.

Neglected bilateral facet dislocation of the lower cervical spine is a rare condition and found mostly in developing countries like Nepal. Delayed presentation makes treatment more challenging concerning decompression, reduction, neurological recovery, and overall outcome. We managed three cases of bilateral facet dislocations of the fifth-sixth-seventh cervical vertebra level presented after three months of injury. All of those were treated surgically by combined anterior-posterioranterior approaches with the same principle. One patient had a complete neurological recovery, the second one recovered partially with few long-term complications and the third one did not improve at all.

Quality of Life in Patients with Spinal Cord Injury Attending Selected Rehabilitation Centers of Nepal.

BACKGROUND: Spinal cord injury is damage to the spinal cord resulting from trauma, diseases or degenerations. The aim of this study is to identify the quality of life among the patients with spinal cord injury in relation to the physical, psychological, social and environmental health. METHODS: This is a cross-sectional study performed within a period of one year in 103 spinal cord injury patients in two different rehabilitation centers of Nepal by using WHOQOL-BREF through face to face interview. The quality of life had been analyzed by descriptive and inferential statistics by using socio-demographic and disease related variables. RESULTS: The study finding revealed that the overall quality of life was impaired in spinal cord injury patients and it was more in psychological (48.17±14.99) and environmental health (38.70±13.79) as compared to physical (55.01±12.77) and social health (51.81±12.89). The mean difference of quality of life score in education (p=0.017), occupation (p= 0.003), and income status (p=0.001) was found statistically significant (p value <0.05) and the highest relationship was found between the psychological health and environmental health (r=0.668). CONCLUSIONS: More than 50%of the spinal cord injury patients had below the average quality of life. Physical health and social health scores are above the average but psychological and environmental health score are below the average. The overall quality of life of Spinal cord injury patients can be improved by modifying psychological health, environmental health, education, occupation, and income status.