Pramod Devkota - Academia.edu (original) (raw)

Papers by Pramod Devkota

Journal of Nepal Medical Association, Jul 1, 2008

Hydatid disease is caused by the tapeworm of genus `Echinococcus. Genus Echinococcus has differen... more Hydatid disease is caused by the tapeworm of genus `Echinococcus. Genus Echinococcus has different species including Echinococcus vogeli, Echinococcus granulosus and Echinococcus multilucularis. Echinococcus granulosus is the most common cause of hydatid disease in humans. This disease can take place either directly through ingestion of parasite eggs from contact with infected dogs or indirectly from the ingestion of contaminated water or food. Infestation of hydatid disease in humans most commonly occurs in the liver (55-70%), followed by the lungs (18-35%). Bone hydatidosis however is very rare,whenever it occurs; it is usually secondary to visceral involvement. We present herein a case of primary hydatid cyst involving superior pubic ramus in a 43 years male patient, which is not a common site for the occurrence of this disease. Diagnosis is usually delayed if high index of suspicion is not there. MRI is a good tool for reaching diagnoses.

$Research paper thumbnail of Outcome of tibial diaphyseal fracture fixation with Surgical Implant Generation Network (SIGN) nail$

Journal of Patan Academy of Health Sciences, Dec 31, 2019

Introductions: Fractures of diaphyseal region of the tibial bone are amongst the most commonly se... more Introductions: Fractures of diaphyseal region of the tibial bone are amongst the most commonly seen extremity injuries in the developing countries. The surgical implant generation network (SIGN) intramedullary (IM) nail was designed for the treatment of long bone fractures in the developing nations. Methods: From March 2008 to December 2018, a total of 104 patients with 104 tibial diaphyseal fractures were treated with SIGN IM nail. The followup visits were arranged at 6, 12, 24 weeks and one-year post operatively. During followup visits, the signs of fracture union clinically as well as radiologically and the presence of complications any were recorded and analyzed. Results: The mean age of the patients was 32.81 (16-65) years, male 74 (71.2%) and female 30 (28.8%). Majority of the patients 70 (67.3%) had fractures after road traffic accidents. The mean time of surgery was 13.58 (1-463) days. Six (5.8%) patients had delayed union and no non-union was detected. We had 10 cases (9.6%) of mal-alignment but were on acceptable range. Conclusions: In the developing country like Nepal, the SIGN nail is an effective surgical implant for the management of the tibial diaphyseal fractures with good result of fracture union and low rates of nonunion, mal-alignment and manageable complications.

$Research paper thumbnail of Bilateral impacted femoral neck fracture in a renal disease patient$

Nigerian medical journal : journal of the Nigeria Medical Association, 2013

Consent from the relevant authority and from the patient was obtained to publish the case. There ... more Consent from the relevant authority and from the patient was obtained to publish the case. There was no history of injury, trauma, fall, seizure, steroid medication, fluoride treatment, smoking and alcohol abuse. On physical examination there was no active bilateral motion of the hips and very painful on passive movement. Pelvic radiograph examination did not clearly show fractures but the shortened neck of femur was seen and suggesting femoral neck fracture. The routine blood examination showed that she had moderate anaemia and serum urea was 17.6 mmol/L (normal value: 2.5-14.5), creatinine was 401.02 umol/L (normal value: 50.4-98.1), calcium total was 2.39 mmol/L (normal value: 2.10-2.55), phosphate inorganic was 1.07 mmol/L (normal value: 0.74-1.52), vitamin D was 53.48 pmol/L (normal value: 60-108) and para-thyroid hormone level was 105.37 ng/L (normal value:10-65). Computed tomography (CT) of pelvic [Figure 1] was performed and showed the impacted bilateral fractures of neck of femurs with minimal right varus angulation. Multiple vertebral bodies' collapses are also present with severe and diffuse reduction in mineralization. Gibbous deformity present due to the fractures of vertebral bodies of (thoracic spine) T6, T7, T8, T10 and (lumbar spine) L1. Bilateral hydro-nephrosis and thickening of the bladder wall were found on abdominal ultrasonography. The patient and relatives were educated on the possible complications of the treatment of bilateral femoral neck fracture and they decided not to go for any surgical intervention. She was not able to walk and mobilised on wheel chairs only. After one year of bilateral femoral neck fracture, she is still alive and on regular dialysis with wheel chair mobilisation.

Journal of Nepal Medical Association, Nov 22, 2020

A 20-year-old male presented to our outpatient department with stiffness in his right elbow. He g... more A 20-year-old male presented to our outpatient department with stiffness in his right elbow. He gave a history of sustaining a fracture around the same elbow when he was 4 years old. He was treated operatively for the same. In the postoperative period, he did not undergo any physiotherapy. On examination, he had a fixed flexion deformity in his right elbow with a range of motion between 90 and 110 degrees. The X-ray did not show any bony abnormalities and magnetic resonance imaging revealed susceptibility artifacts in the posterior aspect. The elbow was approached anteriorly releasing all the soft tissue contractures. The elbow was immobilized in extension in a plaster cast for 4 weeks. The patient was under regular physiotherapy after plaster removal in the post-operative period. At one year follow up, he has an elbow range of motion between 20 and 120 degrees.

Revista Brasileira de Ortopedia, Sep 1, 2018

A condromatose sinovial é uma artropatia benigna raramente vista em articulaç ões diartrodiais. A... more A condromatose sinovial é uma artropatia benigna raramente vista em articulaç ões diartrodiais. A condromatose sinovial simétrica bilateral extra-articular do ombro é a variedade mais rara. O diagnóstico é estabelecido com a ajuda de exames de imagem e histopatológicos. Este relato descreve o caso de uma paciente de 39 anos, com aumento de volume progressivo simétrico sobre a região bilateral do ombro com 12-18 meses de duração com dor entorpecido e limitação dos movimentos das articulaç ões do ombro. A ressonância magnética e a ultrassonografia revelaram um grande aumento de volume da bursa subacromial subdeltoidea bilateral com corpos livres flutuantes. A excisão cirúrgica extensa da bursa bilateral foi feita com quatro semanas de intervalo. O exame histopatológico revelou condromatose sinovial em ambos os lados. A recuperação pós-operatória transcorreu sem complicaç ões.

Journal of Patan Academy of Health Sciences, May 8, 2020

Introduction: The COVID-19 pandemic has paralyzed the world, including elective health care servi... more Introduction: The COVID-19 pandemic has paralyzed the world, including elective health care services. To prevent the spread of infection, most countries have gone into lockdown and adjustments have been made to provide urgent medical care, including Orthopaedic services. In accordance with the guidelines from worst affected countries and neighboring India, Patan Hospital followed instructions from Ministry of Health and Population to provide only urgent and semi-urgent Orthopaedic services. This study aims to audit the patient profile during lockdown so as to have a clearer picture, which will enable us to be prepared for similar epidemic in the future. Method: All patients admitted to the Orthopaedic ward of Patan hospital from 24 March to 27 April 2020, during the lockdown, were included. Clinical profile, including cause of admission, management, hospital stay were descriptively analyzed. Ethical approval was obtained. Result: Out of 44 admissions, there were male 27 and female 17. Trauma cases were 38, and 18 were in age group 20-26 years. Admission due to infections were four. Conservative management were done in seven while 33 were treated surgically, out of which 30 accounted for trauma. Average 6.14 days hospital stay, range 1-22 days. Conclusion: Trauma comprised of major bulk of patients seeking urgent Orthopaedic care. Hospital needs to be prepared with necessary measures to ensure safety of health care workers and yet provide urgent Orthopaedic services.

Revista Brasileira De Ortopedia, May 29, 2020

Journal of Patan Academy of Health Sciences, Dec 30, 2018

Introductions: The incidence of Achilles tendon rupture has been increasing worldwide. The optima... more Introductions: The incidence of Achilles tendon rupture has been increasing worldwide. The optimal management of this problem is controversial but the surgical intervention is being applied widely. Methods: We retrospectively analyzed patients who had Achilles tendon (AT) rupture treated surgically at Patan Academy of Health Sciences from January 2010 to December 2015. Functional outcome assessment of ankle was done by using American Orthopedic foot and Ankle Society Score (AOFAS). Results: Total 71 patients (male 45, female 26) had surgery for AT, 38 right and 33 left side. The mean age of the patient was 36.14 years (range 18-67 years). The mean AOFAS score was 83.32 (range 75-93) after first year follow up and 90.36 (range 80-99) after second year, difference was statistically significant (p<0.05). Conclusions: The study showed high AOFAS score for surgical management of ruptured Achilles tendon.

Revista Brasileira de Ortopedia, Aug 27, 2019

Objectives Most of the fractures of the bones of the forearm in children are successfully treated... more Objectives Most of the fractures of the bones of the forearm in children are successfully treated conservatively with closed reduction and casting. The outcomes remain variable and the patients may require additional fracture manipulation or formal surgical intervention due to residual angulations. The present study assesses the radiological and functional outcomes of treating displaced forearm fractures in children with intramedullary flexible titanium elastic nailing. Methods A total of 31 patients aged between 7 and 15 years old with displaced forearm fractures underwent flexible titanium elastic nailing. The patients were followed-up for a mean period of 8.51 months (range: 6-12 months) and were assessed for radiological and functional outcomes. The Price criteria were used to assess the functional outcome. Results Out of 31 patients, 21 patients underwent closed reduction, and 10 required a minimal opening of the fracture site during reduction. A total of 29 patients had excellent results with normal forearm and elbow range of motion (ROM), and 2 patients had good results. In all patients, good radiological union was seen at an average time of 7.9 weeks. Five patients had minor complications, such as skin irritation over the prominent ulnar nail (n ¼ 2), superficial nail insertion site infection (n ¼ 2), and backing out of the ulnar nail (n ¼ 1), requiring early removal. Conclusion Flexible nailing is an efficient application of internal fixation for shaft fractures of both bones of the forearm in children, enabling early mobilization and return to the normal activities of the patients, with low and manageable complications. Resumo Objetivos A maioria das fraturas dos ossos do antebraço em crianças é tratada com sucesso de forma conservadora com redução fechada e imobilização gessada. No

arXiv (Cornell University), Aug 19, 2020

Many governments have managed to control their COVID-19 outbreak with a simple message: keep the ... more Many governments have managed to control their COVID-19 outbreak with a simple message: keep the effective 'R number' R<1 to prevent widespread contagion and flatten the curve. This raises the question whether a similar policy could control dangerous online 'infodemics' of information, misinformation and disinformation 1,

Malaysian orthopaedic journal, Mar 1, 2015

Traumatic hip dislocation in children is relatively rare accounting for about 5% of all hip dislo... more Traumatic hip dislocation in children is relatively rare accounting for about 5% of all hip dislocations. Most of the hip dislocations seen in children are of the posterior type but the much rarer anterior and anterior-inferior (obturator) types have also been described. We present the case of an eight years old girl with an obturator type of hip dislocation following trivial trauma. She was treated with closed reduction and immobilisation in skin traction for three weeks. She was followed up closely for one year and did not develop any complications during that period.

Revista Brasileira de Ortopedia, May 29, 2020

Malaysian orthopaedic journal, Mar 1, 2013

Hands are essential organs and their agility and dexterity are vital to our daily lives. In the p... more Hands are essential organs and their agility and dexterity are vital to our daily lives. In the present study, we analysed 107 patients who presented at the local hospital with hand injuries sustained in the oil fields, oil industries and related employment sectors from the surrounding regions. All the patients were male and the mean age was 37.89 years (range, 21-61y). Forty-seven (43.93%) patients had simple cut injuries, 14 patients (13.08%) had tendon injuries, 13 patients (12.14%) had amputation of the digit (30.84%) had bone fractures (including 20 (66.66%) open fractures). Only 19 (17.75%) patients were admitted in hospital for further treatment. Ninety-one (85.04%) patients injured within one year of employment and 57(53.27%) patients were not satisfied with instructions and orientation before starting their job. Hand injury is one of the most common injuries in the oil industry and overtime work further increases incidence of this injury.

Journal of Nepal Medical Association, 2009

Juxta-articular, subperiosteal osteoid osteomas arising around the ankle are unusual. Tumors aris... more Juxta-articular, subperiosteal osteoid osteomas arising around the ankle are unusual. Tumors arising on the neck of the talus commonly produce symptoms mimicking monoarticular arthritis. Patients are usually treated for arthritis or ankle sprain, which often leads to a delay in definitive diagnosis. Here we present a case of osteoid osteoma of neck of talus which was presented as ankle pain. It puzzled us until MRI was done. Diagnostic dilemma and delay can be avoided by high index of suspicion. The patient was treated with open removal of the tumor. We also present brief review of literature about juxta-articular, subperiosteal osteoid osteoma which is uncommon from the typical osteoid osteoma occurring elsewhere in the body.

Journal of Nepal Medical Association, Nov 2, 2022

Kaplan's lesion is a rare complex metacarpophalangeal joint dislocation. A 7-year-old female chil... more Kaplan's lesion is a rare complex metacarpophalangeal joint dislocation. A 7-year-old female child presented with pain, swelling and inability to move her right index finger. Her mother gave a history of sustaining a fall injury on the same hand around 3 weeks back. Radiographs showed a complex dorsal metacarpophalangeal joint dislocation. As the injury was already 3 weeks old at presentation, a few attempts at closed reduction were tried, under anaesthesia, which was unsuccessful. So, the patient underwent open reduction through a dorsal approach. At a 1-year follow-up, the patient was pain-free and had regained full range of motion of the index finger metacarpophalangeal joint. The differential diagnosis of Kaplan's lesion should be considered when a child presents with finger dislocation.

Journal of Orthopedics and Joint Surgery, Jan 28, 2022

Computed tomography (CT) scan was not done regularly and also not required. Inclusion criteria we... more Computed tomography (CT) scan was not done regularly and also not required. Inclusion criteria were: (1) Patient managed at the hospital with TDH, dislocation reduced closely and surgical intervention done for acetabular fractures or other associated injuries; (2) Information available of the patient of 1 year after a dislocation. Exclusion criteria were: Dislocation of the hip due to pathological and congenital reasons, dislocation reduced by open surgical intervention, dislocation with acetabular fractures which was operated and adequate information not available on the records of the patient. Emergency reduction done and immobilization with skin tractions for 3 weeks in the hospital done. Discharged from the hospital and advised for non-weight bearing (NWB) crutch walk for another 3 weeks advised. We analyzed the epidemiological parameters like gender, age, and nationalities for each patient. The common causes of dislocations, a pattern of dislocation and associated injuries, IntroductIon Traumatic dislocation of the hip (TDH) is an orthopedic emergency that is commonly due to high-energy trauma and it can cause serious permanent disability. 1 Road traffic accidents (RTA) is the major cause of the TDH, and the condition is worsened when associated with the acetabular or femoral head fracture. 2,3 The incidence of hip dislocation is 5.2% and it is the most common joint to dislocate in the lower extremity. 4 Prompt recognition and early reduction with adequate stabilization is crucial for the successful functional outcome. 5 Traumatic dislocation of the hip is classified as anterior, posterior, central, and posterior dislocation is the commonest one. 6 The posterior dislocation is caused by forced adduction with internal rotation and some degree of flexion of the hip. 7 The hip dislocation with or without acetabular fracture is largely dependent on the direction of the femoral head at the time of injury and the increased flexion, adduction is more likely to cause a simple dislocation with the femoral anteversion may predispose patients to simple hip dislocations. 8 Generally, isolated hip dislocations are treated by closed reduction with immobilization. The delay in the reduction may result in avascular necrosis (AVN) of the femoral head, post-traumatic arthritis, and ankylosis of the hip joint. 9 Irreducible dislocations, incongruent reductions, and associated fractures may require successive operative intervention. 10 This study aimed to review the common causes of traumatic hip dislocation, the demography, and the pattern of dislocations with associated fractures, injuries in a public general hospital. MaterIals a n d Methods This is a descriptive retrospective observational study of cases hospitalized for traumatic hip dislocation at a public general hospital

Hong Kong journal of orthopaedic research, Aug 30, 2021

Background: Lower limbs ulcers and wounds, Charcot foot with the presence of peripheral neuropath... more Background: Lower limbs ulcers and wounds, Charcot foot with the presence of peripheral neuropathy or peripheral vascular disease are common complications of the diabetes mellitus (DM). Major extremity amputations (below and above knee) are one of the common surgical procedures performed due to DM complications. Objective: To review the amputations performed due to diabetes mellitus (DM) complications with other associated illness, commonly isolated bacteria, and the demography of the patients in a public general hospital. Materials and Methods: We retrospectively reviewed the cases of above and below the knee amputations due to DM complications from January 2012 to December 2016. The age, gender, duration of DM anyone having, bacteria isolated, vascular condition of the lower limbs, other diseases anyone having, post-surgery wound conditions and status of the ambulation after surgery were analyzed. Results: A total of 53 amputations of the limbs of 51 patients were performed. Below knee amputations were performed on 43 (81.83%) limbs and male gender were 35(68.62%). The mean age of the patient was 57.6±12.01 years (range 31-91 years). The three most common bacteria isolated were Klebsiella pneumoniae, Staphylococcus aureus, Enterobacter cloacae. About 85% of these bacteria were sensitive to commonly used first line of antibiotics like co-amoxiclav and ciprofloxacin. Fifty cases (98.03%) had diabetes for more than five years. End stage renal disease (ESRD) and ischaemic heart disease (IHD) were the other common co-morbidities observed. Conclusion: Major lower limb amputations (below and above the knee) due to uncontrolled blood sugar are common surgical procedures performed on DM. Majority of the bacteria were sensitive to commonly used first line of antibiotics but still 15% were not sensitive and bacteria isolation, sensitivity with the drugs were also important for the treatment of the infection.

Asian Spine Journal, 2014

Revista Brasileira de Ortopedia, Oct 1, 2021

Palavras-chave ► clavícula ► fraturas ósseas ► procedimentos cirúrgicos minimamente invasivos ► p... more Palavras-chave ► clavícula ► fraturas ósseas ► procedimentos cirúrgicos minimamente invasivos ► placas ósseas ► fixação interna de fraturas Resumo Objetivo Analisar o resultado radiológico, clínico e funcional das fraturas da clavícula, tratadas pela técnica de osteossíntese com placa minimamente invasiva (MIPO). Métodos De junho de 2018 a julho de 2019, um total de 17 casos de fraturas claviculares foram tratadas com a técnica de osteossíntese com placa minimamente invasiva (MIPO), sob fluoroscopia com o braço em C. Os resultados funcionais foram avaliados por meio do escore de Constant-Murley e pelo escore de incapacidade do braço, ombro e mão (DASH). Foram analisados os resultados clínicos de consolidação, complicações, tempo cirúrgico, permanência hospitalar e infecção. Resultados O tempo médio de acompanhamento neste estudo foi de 10,41 AE 1,75 meses (variação, 8 a 14 meses). Havia 11 pacientes do sexo masculino e seis do feminino, com média de idade de 39,05 AE 10,76 anos (variação de 22 a 57 anos). Todas as fraturas se consolidaram no tempo médio de 15,35 AE 3,08 semanas (variação, 12 a 20 semanas). O tempo cirúrgico médio foi de 98,11 AE 13,83 minutos (variação, 70 a 130), sendo a permanência hospitalar média de 4,7 AE 1,12 dias (variação de 3 a 7). O escore de Constant-Murley médio foi de 74,82 AE 6,36 no 4°mês e 92,35 AE 5,48 no 8°m ês do pós-operatório, o que foi estatisticamente significativo. O escore DASH médio foi de 9,94 AE 1,55 no 4°mês e 5,29 AE 1,85 na 8ª semana do pós-operatório, também sendo estatisticamente significativo. Um paciente apresentou infecção cutânea superficial no local da incisão. Conclusões A técnica MIPO é um método alternativo para a fixação de fraturas da clavícula, porém é tecnicamente mais desafiador, já que necessita de instalações cirúrgicas mais bem equipadas.

Hong Kong journal of orthopaedic research, Aug 30, 2020

Subluxation or dislocation of the peroneal tendon is uncommon ankle disorder and most of the time... more Subluxation or dislocation of the peroneal tendon is uncommon ankle disorder and most of the time misdiagnosed as ankle sprain. Young adults and adolescents who are active on sports activities are more prone to get this problem. The main cause of this disorder is because of the superior peroneal retinaculum avulsion from its insertion with fibular bone. We report a case of peroneal subluxation in a 19-year-old girl after twisting of the ankle one year back. She was initially treated with ankle splintage, rest and analgesics but her problem did not improve. Magnetic resonance imaging (MRI) of the ankle showed subluxation of the peroneal tendon and managed operatively. One year after the operation she is having pain-free ankle without any difficulties for walking.