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Introduction: Magnetic resonance imaging is a noninvasive diagnostic modality and provides clinically relevant information to orthopaedic surgeons by detecting and characterizing injuries of cruciate ligaments and meniscus of the knee. MRI is routinely used before arthroscopic examination and surgery. Arthroscopy is considered the reference standard for the diagnosis of injuries of cruciate ligaments and meniscus of the knee and hence the efficacy of MRI needs to be compared with arthroscopic findings. Methods: This was a retrospective observational study at Bheri hospital, Nepalgunj. A total of 114 Patients who were investigated with MRI and managed with arthroscopic procedures for a knee injury, between June 2017 to February 2022, were included in the study.Data analysis was done for determining true positive, true negative, false positive and false negative as per MRI and arthroscopic findings.Sensitivity, specificity, positive predictive value and negative predictive value were calculated based on specific equations. Results: The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of MRI for ACL were 89.65%, 96.42%, 96.29%, 90% & 92.98%, PCL was 96.42%, 100%, 100%, 97.72% & 99.12%, the medial meniscus was 88.46%, 88.70%, 86.79%, 90.10% & 88.59% and lateral meniscus was 84.61%, 94.31%, 81.48%, 95.40% & 92.10% respectively. Conclusions: MRI is an excellent noninvasive modality for imaging the knee and it yields high accuracy in diagnosing injuries of cruciate ligaments and meniscus.

Background: Arthroscopic anterior cruciate ligament reconstruction can be performed both with titanium and bioabsorbable interference screws. The purpose of this study was to com­pare functional outcomes after reconstruction using these different implants. Methods: This was a retrospective study. Patients who underwent ACL reconstruction with ham­string autograft at Bheri hospital over the designed period were observed. Each group (titanium and bioabsorbable screws) consisting of 20 patients were compared using Lyshlom knee scores at 3, 6 and 12 months postoperatively. Statistical analysis was done using SPSS version 24. Chi square test was applied for comparing functional outcomes. Confidence interval of 95%, p value less than 0.05 was taken as significant. Results: Mean Lyshlom scores at 3, 6 and 12 months were 61.70, 69.60 & 85.90 for titanium group and 62.65, 70.95 & 84.65 for bioabsorbable screw group. The differences were not statistically significant. Conclusions: Functional outcomes at each follow up was equivalent among patients using either titanium or bioabsorbable screws.

Introduction: Orthopaedic surgical activity has been significantly affected by COVID-19 pandemic. The decision to perform operative interventions is based on balancing risk to benefit to the patient and health care workers. Though different guidelines have been published, there is a lack of reliable data on orthopaedic surgical activities. Our study aimed to evaluate the impact of the COVID-19 pandemic on Orthopaedic surgeries comparing with the previous year. Methods: This was an epidemiological retrospective comparative study conducted at Shree Birendra Hospital, Nepal after taking ethical approval from the Institutional Review Committee of NAIHS. Data of the first four month of orthopaedic surgeries after National lockdown (from March 24 to July 23, 2020) and the same four month period of the previous year (The year 2019) were retrieved. The demographic profiles and operations categories (trauma, elective and infections) were compared between two periods using SPSS 21. Result: Out of total of 651 patients enrolled, 169 patients operated during the pandemic compared with 482 patients before the pandemic. There was a 65% reduction in total surgical procedures, 94% reduction in elective cases and trauma cases were reduced by 29% (P < 0.05). Implant removal (107, 42.8%) constituted the highest elective cases in the year 2019. Conclusions: The orthopaedic surgical procedures were decreased in frequency during COVID-19 because of a decrease in elective cases. The total trauma patients remained more equable during pandemic despite strict lock-down. Health care facilities should consider this during post pandemic recovery.

Objectives: Incorrect placement of the femoral tunnel can result in failure of anterior cruciate ligament reconstruction. Several techniques have been described in literature to make accurate femoral tunnel. Although eyeballing and femoral offset aimer are commonly used, they are considered to be less accurate if used in isolation. To the best of our knowledge, no study has evaluated the use of combination of eyeballing and offset aimer to make the femoral tunnel. This study aims to evaluate the position of femoral tunnel made by combination of eyeballing and femoral offset aiming device. Materials and Methods: Post-operative radiographs of 50 patients were assessed. True anteroposterior (AP) and lateral view radiographs were used to evaluate the placement of the femoral tunnel using standard methods. The outcome was assessed and compared with the standard location of femoral tunnel as described by Harner et al. and Aglietti et al. Ease of making femoral tunnel and posterior blowout were recorded. Data analysis was performed using Statistical Package for the Social Sciences version 25 statistical analysis software. Results: In the coronal plane (AP view), the mean position of the femoral tunnel from the lateral cortex was at 35.09% ± 3.9% point. In AP plane (lateral view), the mean position of the femoral tunnel was at 80.01% ± 8.02% posteriorly along the Blumensaat’s line. None of the cases had posterior blowout and the technique was said to be easy. Conclusion: Eyeballing supplemented with transportal femoral offset aimer is an easy and accurate method of placing femoral tunnel and avoids posterior wall blowout.

Introduction: Knee injuries are common among active adults. Achieving a correct clinical diagnosis is often difficult in acute presentations. Knee arthroscopy is considered the gold standard in diagnosing post-traumatic intra-articular lesions, but it is an invasive procedure requiring a certain degree of expertise. Magnetic Resonance Imaging (MRI) is a non-invasive, sensitive diagnostic tool for knee injuries. This study aims to correlate the findings of MRI with arthroscopy of the knee. Method: This Prospective Observational Study was done at Shree Birendra Hospital, Kathmandu, Nepal from 13 Feb 2016 to 13 Jun 2016. The sensitivity, specificity, and accuracy of MRI findings in ligamentous, meniscal, and osteochondral injuries of the knee were analyzed using arthroscopic findings as standard. Result: Fifty-two patients (35 male and 17 female), mean age 35.4 years were included in the study. The accuracy of MRI for anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial meniscus, lateral meniscus, and chondral lesions of the knee were 94%, 100%, 92%,86%, and 86% respectively. Conclusion: The MRI is accurate (86-94%) in diagnosing Meniscal and Ligamentous injuries of the knee. It has poor sensitivity (22%) for chondral lesions.

Introduction: Postural headache occurs in up to 70% of the patients who receive spinal anaesthesia. They further experience difficulty in bladder voiding. Both of these complications deter the orthopaedic patients who undergo procedures in the lower limb from having early mobilisation. It is widely suggested that a period of bed rest is necessary to avert spinal headache whereas early mobilisation aggravates the condition. The aim of our study was to compare the effect of body position on post-lumbar puncture headache and urinary retention after spinal anaesthesia in orthopaedic patients. Methods: We did a prospective randomised single-center study in a leading teaching institute of our country. There were 200 patients. Initially they were randomly divided into two groups- study and control- to see if there was any correlation between body position and PLPH. Since the body posture post-operatively was not found to be initiating factor for PLPH, whole of the 200 patients were analysed together for other criteria. Results: We had 37 patients (18.5%) who had PLPH among the 200 patients. The number of patients developing the condition in study and control groups were 17 and 20 respectively. A total of twenty-three patients (11.5%) needed catheterisation in post-operative ward, the age group mostly needing Foley’s catheter was 41-60 yrs. More patients in control group (16 out of 100) given bed rest to prevent PLPH needed urinary catheterisation.Conclusions: Body position after spinal anaesthesia does not contribute to onset of PLPH. Moreover, the incidence of urinary catheterisation was more in patients given bed rest , which delayed mobilisation. We conclude that the patients need not be given strict bed rest in supine position after the lower limb procedures to facilitate early bladder voiding and mobilisation.

Calcific tendinitis occurs frequently in shoulder and hip region. Its occurrence in elbow joint is frequently misdiagnosed because of its rare incidence and similar clinical presentation with other acute conditions of elbow like trauma, infection and tennis elbow. Characteristic symptoms of this condition are acute onset of pain, tenderness and swelling on the lateral aspect the elbow. Plain Radiograph is the primary modality to distinguish and evaluate this condition. Awareness and familiarity with this condition helps in early diagnosis and avoids unnecessary treatments and biopsy as this condition is self-limited.Keywords: Calcific tendinitis; self-limited; tennis elbow.

Fracture of Patella is rare and constitutes almost 1% of all skeletal injuries. Bilateral fracture of patella is even rarer accounting for 2.9% of all patella lesion. Very few cases of bilateral patella fractures have been reported in literature. We report the rare case of bilateral patella fracture in a healthy female and discuss the management challenges. doi: http://dx.doi.org/10.3126/mjsbh.v13i1.13005

Osteoid Osteoma is benign bone forming tumor commonly occurs in lower limbs. Osteoid Osteoma of upper limb is rare, and it is extremely rare in hands. We report a case of a 20 year old male who presented with complaints of pain in nail bed of left little finger over a period of one year with gradually increasing swelling and deformity of nail. Radiological examination revealed a well-defined lytic lesion with sclerotic margin at distal phalanx with a nidus at center. Curettage and removal of nidus was done under digital nerve block. He was symptom free from next day of surgery and the tip of the finger has significantly regained its original shape over a period of two years. The aim of this paper is to report yet another uncommon case of osteoid Osteoma located at distal phalanx of little finger.Medical Journal of Shree Birendra Hospital; July-December 2012/vol.11/Issue2/46-49 DOI: http://dx.doi.org/10.3126/mjsbh.v11i2.7911

Introduction: Joint replacement surgery, has become one of the most frequent prosthetic surgeries over the past decades due to its success in restoring function to disabled arthritic individual. A two-stage revision arthroplasty is a well-accepted method for the treatment of a deep infection of a hip with a joint implant. In the present study, the results of three infected hips with the interim use of an indigenous cemented prosthesis along with gentamycin impregnated cement beads were assessed with a two stage revision. Methods: Three consecutive patients who were managed with a two-stage revision hip arthroplasty for the treatment of a previous infection, with retained implants, were followed clinically and radiographically for an average of 15 months. Following removal of implants and debridement (first stage), an indigenous medicated prosthesis along with antibiotic coated cement beads were implanted, for an interim phase of six - eight weeks aft er which a new prosthesis was placed ( second stage ).In this period antibiotics ( both intravenous and oral) were administered to the patients. Results: In a mean follow up period of 15 months, there is no evidence of recurrent infection in all three patients, as of now. The use of antibiotic coated cement prosthesis along with gentamycin mixed cement beads was associated with a satisfactory hip score, and better walking capacity in the interim period, a lower transfusion requirement at the time of reimplantation, and no postoperative dislocation. Conclusions: Locally prepared medicated spacer and gentamycin coated beads help in eradicating hip infection, besides being more cost effective. Medical Journal of Shree Birendra Hospital; Jan-June 2012/vol.11/Issue1/32-36 DOI: http://dx.doi.org/10.3126/mjsbh.v11i1.7765

Introduction: Stress fractures are common during military training but femoral neck stress fractures are uncommon and sometimes pose diagnostic and therapeutic challenges. An incomplete stress fracture with excellent prognosis, if left unprotected, can lead to displaced femoral neck fracture with almost 63% complication rate even with best of the treatment. The aim of this study was to analyze various aspects of the femoral neck stress fracture so that early diagnosis can be made to prevent devastating complications like osteonecrosis and non-union. Methods: The four year army hospital record of 16 patients with femoral neck stress fracture were studied. Their demographic profi le, type of fracture, presentation delay, on set of clinical symptoms and complication of femoral neck stress fracture were critically analyzed. Results: The mean age of the patient was 19.94 years. Total 74% of them developed fi rst symptoms of stress fracture between four to seven weeks of training. There was 3.4 weeks delay from the clinical onset of symptoms to the diagnosis of stress fracture. The type of femoral neck stress fracture were compression (31.25%), tension (18.75%) and displaced (50%). Out of eight displaced type of fractures, 5 (62.5%) had developed complications (3 osteonecrosis and 2 nonunion). Conclusions: Femoral neck stress fracture occurs in initial four to seven weeks of training. The high index of suspicion in initial period of training can help to detect and decreases significant morbidity. Key Words: displaced stress fractures, non-union, osteonecrosis, recruits

Introduction : Shoulder dislocation is common injury requiring urgent reduction. For the reason that patient is not nill orally and anesthetists are not available, reduction under intra venous anaesthesia is not possible. This study was aimed to evaluate the effectiveness of intraarticular lidocaine and stimson’s technique of shoulder dislocation, which could be performed without anesthetist and irrespective of nill orally status. Methods: A prospective observational study was performed from December 2009 to December 2010. Under all antiseptic precautions 20 ml of Lidocaine was injected intraarticularly and reduction was performed by Stimson’s technique. Visual Analogue Score, time for reduction and failure to reduction by this technique was recorded. Results: Out of 27 dislocations 22 were successfully reduced and remaining required added scapular manipulation. The mean VAS scor was 2.3±1.26 and the mean time of reduction was 17.96±1.9 minutes. Conclusion: Stimson’s method with Intraarticular Lidocaine is effective, safe, less costly and can be performed in periphery where anesthetist and monitoring facilities are not available. DOI: http://dx.doi.org/10.3126/mjsbh.v10i1.6406 Medical Journal of Shree Birendra Hospital Jan-June 2011 10(1) 6-8