P Chaudhary

Fixation of greater tuberosity fracture in rare unstable bilateral glenohumeral joint dislocations with bilateral fractures of the greater tuberosities: A case report

Introduction: Unstable dislocations of the bilateral glenohumeral joint with fractures of both greater tuberosities are very rare. Case presentation: A 48-year-old gentleman sustained a bilateral anterior dislocation of his glenohumeral joint with fractures of the greater tuberosities on both sides after an episode of seizure. Attitude of both shoulders were abducted and externally rotated. Radiological examination revealed the dislocations of bilateral glenohumeral joint and also the fractures of the bilateral greater tuberosities. Closed reduction and shoulder derotation immobilizer was applied. The Reduction was unstable and needed fixation of both sides greater tuberosity with cannulated cancellous screws. The shoulders were immobilized for 3 weeks and subsequent rehabilitation yielded a good outcome. Results at 6 months follow-up were satisfactory with normal range of motion and no redislocations occurring. To our knowledge, this is the first reported case of bilateral unstable glenohumeral joint dislocation associated with fractures of both greater tuberosities in a middle aged man which was unstable needing fixation of greater tuberosities fractures. Conclusion: Bilateral glenohumeral joint dislocations with bilateral fractures of the greater tuberosities may be unstable needing fixation of greater tuberosity fracture. Health Renaissance 2015;13(2): 173-177

An isolated capitellum fracture of the humerus in adult: A rare case report

Introduction: Isolated capitellum fractures are rare and represent only 1% of all elbow fractures and 6% of distal humeral fractures. Case description: A 45-year-old right hand dominant female presented to us with pain and stiffness in her left elbow following a fall onto the outstretched hand that occurred 6 months prior. She had capitellum fracture with avascular changes and excision of the fractured fragment was done. Physiotherapy was initiated with outcome of nearly normal elbow function. At the time of injury, she was unable to move her elbow actively due to pain and she was misdiagnosed as soft tissue injury earlier in a local hospital. Conclusion: Possibility of rare diagnosis such as capitellum fracture should also be kept in mind while treating elbow injuries.

Transfer of technology regarding correction of congenital talipesequinovarus by ponseti method of treatment to doctors working at peripheral hospitals of eastern region of Nepal covered by BPKIHS, Dharan.

Background: Ponseti method of manipulation and casting has been standard non operative method of treatment for idiopathic clubfoot. We have conducted this study to find out whether Ponseti method of correction can be taught to doctors working at district hospital. Objective: To assess the knowledge, familiarize the Ponseti method of correction and to decrease the need of surgery regarding the congenital talipesequinovarus. Method: We conducted prospective study among doctors working in the district hospitals of eastern Nepal. We assessed knowledge and practice regarding clubfoot management before and after the intervention by questionnaire based method. The data were analyzed using before and after difference for magnitude and paired t test for significance. Result: 13 doctors were included in the study. Among 13 participants, one (7.69%) had formal orthopedic training. Only 30% of the participants had more than 60% correct response regarding questionnaires regarding knowledge of clubfoot. 40% of participants had done referral of cases to orthopedic centre. One (7.69%) of the participants had applied Ponseti cast. 61% percent of the participants responded more than 60% correctly at the final follow up at one year. Conclusion: The study shows that the knowledge and practice regarding Clubfoot correction is inadequate and hence teaching of Ponseti method was useful in the district hospital. Health Renaissance 2015;13(2): 144-152