Background:The manipulation and corrective cast application for club foot was known to be done by Kite's method. The Kite's method of manipulation (center of rotation of malaligned foot and fulcrum on cuboid) was modified by Ponseti (fulcrum on head of talus). Recently, Ponseti's method has gained popularity and vastly improved results are reported. We report randomized controlled trial where manipulation of club foot was done by Ponseti's and Kite's method and correction evaluated by Pirani score to compare the outcome of treatment.Materials and Methods:Sixty feet in 38 patients, 22 with bilateral and 16 with unilateral clubfeet in children less than two years of age and without any prior manipulation or surgical treatment were randomly allocated to the Ponseti (30 feet) and Kite (30 feet) methods of manipulation. This process resulted in the right and left feet of the same patient in 12 bilateral cases being compared with one another (Paired analysis). In the remaining 10 bilateral cases, four patients had both feet treated by Ponseti and six had both feet treated by Kite (unpaired analysis). Finally, in 16 unilateral cases, 10 feet were allocated to the Ponseti and six to Kite methods of manipulation (unpaired analysis). Feet were followed up weekly for 10 weeks for change of cast and recording of hindfoot, midfoot and total Pirani scores. Correction was measured as a difference between hindfoot, mid foot and total Pirani scores weekly from weeks 1 to 10 and corresponding baseline scores. Absolute correction and rate of correction in (i) bilateral clubfeet treated by Ponseti's method on one side and Kite's method on the other side in the same patient were compared using paired Student's t test and (ii) patients with unilateral clubfoot (where either of the methods was used) or those with bilateral clubfoot (where both feet treated by either of the two methods on both the sides) were compared using difference between means (mean correction by Ponseti minus mean correction by Kite) for magnitude of difference and unpaired Student's t test (if data was normally distributed) or Mann Whitney U statistics (otherwise) for significance of difference.Results:In 12 bilateral clubfeet, where one foot received Kite's method and the other Ponseti's manipulation, feet treated by Ponseti's technique showed faster rates of decrease in Pirani score (improvement) as compared to feet treated by Kite's method with the mean of difference between baseline and follow up scores showing significantly greater (P<0.05) difference from zero from fourth week onwards to up to 10 weeks. In unpaired analysis, both for unilateral or bilateral clubfeet, regardless of side, mean Pirani scores in Ponseti feet improved much faster than Kite feet but the difference achieved statistical significance only at the 10th week from the start of treatment.Conclusions:Hind foot, midfoot and total Pirani scores reduce much faster with Ponseti than the Kite's method of manipulation of clubfoot. In paired analysis the difference becomes statistically signific...
Background: Cheiloscopy is a forensic investigation technique that deals with the identification based on lip traces. Based upon the research, it was established that the arrangement of lines on the red part of human lips is unique for each human being. Objectives: To analyze and compare quadrant wise and sex wise predilection of lip print pattern. Methods: A total of 200 (18-25 years) Nepalese undergraduate students of BPKIHS were selected. Thin layer of lip-stick was applied on the lips of these sub-jects. The hinged por-tion of a folded paper was inserted between the lips and the sub-jects were asked to press their lips onto it. Only middle 10 mm of both upper and lower lips were taken as study area. The lip prints, thus obtained were stud-ied on the basis of Tsuchihashi's classification. Chi square test was used to analyze and compare the lip print patterns in all the quadrants of males and females, with the level of significance p<0.05. Results: Type I pattern was predominant in all the four quadrants among males (62%, 56%, 54%, 57% in first, second, third and fourth quadrants respectively). In female also type I was predominant in 2 nd , 3 rd and 4 th quadrant (40%, 45%, 51% respectively) whereas in 1 st( right upper) quadrant type II pattern was predominant (37%). Conclusion: Lip print pattern can be used as an additional tool for personal identification and sex determination. Further work on the subject can help to make cheiloscopy a practical reality in the forensic identification process.
Purpose Long arm cast is the method of immobilization after closed reduction of the fracture of the distal third of the forearm, although short arm cast has been used to immobilize the forearm by some orthopedic surgeons. We conducted this study to evaluate the rate of displacement, union time, complication, and cost of treatment between the above-elbow and below-elbow plaster cast groups. Methods We designed a prospective randomized controlled trial to compare above-and below-elbow casts for patients of distal forearm fracture aged 4-12 years. One hundred and one patients were presented to our institution during the period from 1st June 2007 to 31st May 2008. Twelve patients were excluded from the study. Eighty-nine patients were randomized into two groups. Four patients were lost to follow up. Hence, 85 patients, 42 in the aboveelbow group and 43 in the below-elbow group, were analyzed. Informed consent was obtained prior to participation in the trial. The parameters to be studied were defined before treatment and noted in the pilot-tested pro forma and follow up was done. Results Among the 85 patients analyzed, randomization was successful. Pain and swelling on the next day and at one week following cast application was significantly higher (P = 0.000) in the above-elbow group. Three cases in the above-elbow group needed slitting of the plaster cast. Remanipulation was needed more often in the above-elbow group (9.5%). Although the cast index was not statistically significant (P = 0.054) between the groups, those who needed remanipulation had a larger cast index (0.80). The total cost of the treatment and the number of school days lost was significantly higher (P = 0.000) in the aboveelbow group. Conclusion Below-elbow cast treatment was comparable in terms of redisplacement, union time, and movement of the wrist to the above-elbow treatment. The complications rate and total cost was higher in the above-elbow plaster group, which could be a cost benefit if a below-elbow cast is used.
Malignant peripheral nerve sheath tumors (MPNSTs) are the leading cause of death in young adults and are one of the most frequent non-rhabdomyosarcomatous soft tissue tumors in pediatric age. These tumors usually occur in young adults from a previously recognized neurofibroma, neurofibromatosis type 1 (NF1), with a noted change in size and pain. This child reached the age of 10 without the presence of the more commonly seen manifestations of NF1. Pseudoarthrosis in children has a high rate of association with NF1, and in this case diagnosis of NF1 was supported by development of MPNST in a pre-existing plexiform neurofibroma.
Introduction: There are various implants designed for fixation of trochanteric fracture which can be extramedullary (Sliding hip screw) and intramedullary (Proximal Femoral Nail). A randomized controlled trial comparing these techniques was conducted at BP Koirala Institute of Health Sciences. Objective: To compare efficacy of proximal femoral nail and sliding hip screw in the management of trochanteric fractures. Methods: Patients in both groups were matched for age (mean 67 years, 50 to 100) and gender. We excluded all pathological fractures, patients presenting at more than one week, multiple fractures or any bone and joint disease interfering with rehabilitation. Results: The amount of blood loss and length of incision were significantly higher in the sliding hip screw group (p < 0.05). The time of union, range of movement and Western Ontario and McMasterUniversity knee scores were comparable at two years. The mean Harris hip score was better in proximal femoral group. Conclusion: The number of patients showing shortening, external malrotation and varus angulation was more in sliding hip screw group. There was one case of wound infection and a single case of breakage of implant in sliding hip screw group.
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