Patterns of Orthopaedic Injuries among Motorbike Accident Admissions Presenting to a Tertiary Care Hospital in Kathmandu

BACKGROUND

The anecdotal burden of morbidity secondary to motorbike accidents is thought to enormous by personnel involved in trauma care. The objective of the present study is to ascertain patterns and association of injuries and causes of mortality in a cohort of motorbike accident victims.

METHODS

A retrospective chart review of 1337 motorbike accident admissions B and B Hospital in Kathmandu between January 2009 and December 2010 was undertaken.

RESULTS

Majority of victims were between 20 to 50 years [1230 (92%) males]. Lower extremity injuries comprised on 816 (61% of total admissions). Tibia fractures were the most common injury in isolation, multiple injury, as well as polytrauma, and a vast majority of these were open fractures. Multiple injuries were seen in 82 (6.1%) patients and 33 (2.5% of Total) patients were polytraumatized. An amputation was necessary in 16 (1.2%) patients and emergent fasciotomy for compartment syndrome was necessary in 23 (1.7%) cases of tibia fractures and 39 (2.2%) of foot and ankle injuries. A floating joint injury was present in 24 (1.8%) patients.. A fat embolism syndrome (FES) was diagnosed in 8 (0.6%) patients. The overall mortality was 0.45% (6 patients).

CONCLUSIONS

Motorbike accident is an important cause of morbidity and mortality in Kathmandu, and often involves a very productive age group. There is an imminent need to address this public health problem.

Extra and Intra-articular Synovial Chondromatosis

Synovial chondromatosis is not so rare intra-articular condition secondary to synovial metaplasia, that affects the knee joint. Extra-articular synovial chondromatosis however is an extremely rare condition that usually involves the synovial sheath or bursa of the foot or hand. We present two cases of synovial chondromatosis, one intra and one extra-articular. The first case was a 25 year old lady who presented with pain, swelling and restricted range of motion of left knee and was found to have an intra-articular synovial chondromatosis which was treated successfully by joint debridement. The second case was that of a 22 year old man who presented with right knee pain and was diagnosed to have an extra-articular synovial chondromatosis of his right medial hamstring tendon sheath, excision of which resulted in complete relief of symptoms.

A Snapshot of 1001 Children Presenting with Cerebral Palsy to a Children's Disability Hospital

BACKGROUND

Cerebral palsy (CP) has largely been an unaddressed problem in low and middle income countries (LMIC's). The purpose of this retrospective study is to provide a facility-based snapshot of CP in Nepal.

METHODS

A retrospective chart review of 1001 patients diagnosed as having cerebral palsy, presenting to our institution from December 2008 to December 2011, was carried out.

RESULTS

Majority of cases were found to be a result of birth complications and post-natal infections. Most children with CP were born at home, presented after walking age and came from socioeconomically unstable or borderline households. Less than 20% were attending school. Spastic diplegia was the most common presentation. Children with post-natal spasticity secondary to infection seemed to retain greater ambulatory potential.

CONCLUSIONS

In contrast to CP in developed countries, the etiology in LMIC's is largely related to birth-related complications and post-natal infections. There is an urgent need to address preventable causes of cerebral palsy in Nepal.

The Ponseti method in the treatment of children with idiopathic clubfoot presenting between five and ten years of age

Our goal was to evaluate the use of Ponseti's method, with minor adaptations, in the treatment of idiopathic clubfeet presenting in children between five and ten years of age. A retrospective review was performed in 36 children (55 feet) with a mean age of 7.4 years (5 to 10), supplemented by digital images and video recordings of gait. There were 19 males and 17 females. The mean follow-up was 31.5 months (24 to 40). The mean number of casts was 9.5 (6 to 11), and all children required surgery, including a percutaneous tenotomy or open tendo Achillis lengthening (49%), posterior release (34.5%), posterior medial soft-tissue release (14.5%), or soft-tissue release combined with an osteotomy (2%). The mean dorsiflexion of the ankle was 9° (0° to 15°). Forefoot alignment was neutral in 28 feet (51%) or adducted (< 10°) in 20 feet (36%), > 10° in seven feet (13%). Hindfoot alignment was neutral or mild valgus in 26 feet (47%), mild varus (< 10°) in 19 feet (35%), and varus (> 10°) in ten feet (18%). Heel-toe gait was present in 38 feet (86%), and 12 (28%) exhibited weight-bearing on the lateral border (out of a total of 44 feet with gait videos available for analysis). Overt relapse was identified in nine feet (16%, six children). The parents of 27 children (75%) were completely satisfied. A plantigrade foot was achieved in 46 feet (84%) without an extensive soft-tissue release or bony procedure, although under-correction was common, and longer-term follow-up will be required to assess the outcome.

Clinical, MRI and arthroscopic correlation in internal derangement of knee

BACKGROUND

The traumatic or degenerative internal derangement of the knee requires certain investigations for the establishment of diagnosis, in addition to clinical history and a thorough physical examination. The use of arthrography and arthroscopy improves the accuracy of the diagnosis. MRI scanning of the knee joint has often been regarded as the noninvasive alternative to diagnostic arthroscopy.

OBJECTIVE

The purpose of the study was to correlate clinical and low field MRI findings with arthroscopy in internal derangement of the knee.

METHODS

Forty one patients with suspected internal derangement of the knee were subjected to MR examination followed by arthroscopy. Clinical criteria used were history, mode of injury, Mc Murray, Apley grinding, Thessaly test for meniscal injury. Drawer test was considered to be essential for clinical diagnosis of cruciate ligament injury. MRI of the knee was performed in low field open magnet (0.35T, Magnetom C, Seimens). Arthroscopy was done within two months of MR examination and was considered gold standard for the internal derangement of the knee.

RESULTS

The sensitivity, specificity, diagnostic accuracy of clinical examination were 96.1%, 33.3% and 73.1% respectively for medial meniscal tear; 38.4%, 96.4% and 78.1% respectively for lateral meniscal tear. The sensitivity, specificity, diagnostic accuracy of MRI were 92.3%,100% and 95.1% for medial meniscal tear; 84.6%96.4% and 92.6% respectively for lateral meniscal tear.

CONCLUSION

Clinical examination showed higher sensitivity for medial meniscal tear compared to MRI, however with low specificity and diagnostic accuracy. Low field MRI showed high sensitivity, specificity, diagnostic accuracy for meniscal and cruciate ligament injury, in addition to associated derangement like articular cartilage damage, synovial thickening.